Healthcare Provider Details

I. General information

NPI: 1083385017
Provider Name (Legal Business Name): EMANUEL SANCHEZ SANTIAGO PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: EMANUEL SANCHEZ PHD

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2229 LUANN LN
MADISON WI
53713-4532
US

IV. Provider business mailing address

2229 LUANN LN APT 5
MADISON WI
53713-4551
US

V. Phone/Fax

Practice location:
  • Phone: 608-477-3152
  • Fax:
Mailing address:
  • Phone: 608-477-3152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5459-57
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: