Provider Demographics
NPI:1326383316
Name:SANCHEZ, MARISSA FAUSTINA
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:FAUSTINA
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14577 N DOVE RESERVE DR
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85658-5179
Mailing Address - Country:US
Mailing Address - Phone:480-773-8722
Mailing Address - Fax:
Practice Address - Street 1:3241 E SHEA BLVD STE 1-503
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3335
Practice Address - Country:US
Practice Address - Phone:623-306-2603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ80252355S0801X
AZSLP15733235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant