MEDICARE: GLADYS SANCHEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1750742631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLADYS SANCHEZ

Provider Business Mailing Address
First Line	:	4933 S 1500 W STE 110
Second Line	:
City	:	RIVERDALE
State	:	UT
Zip	:	84405-7738
Country	:	US
Telephone Number	:	801-820-6420
Fax Number	:

Provider Business Practice Location Address
First Line	:	4933 S 1500 W STE 110
Second Line	:
City	:	RIVERDALE
State	:	UT
Zip	:	84405-7738
Country	:	US
Telephone Number	:	801-820-6420
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2016
Last Update Date	:	03/18/2016

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Directions to “ GLADYS SANCHEZ ” Practice Location

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