Basic Information
| Provider Information | |||||||||
| NPI: | 1154589125 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANCHEZ | ||||||||
| FirstName: | BETH | ||||||||
| MiddleName: | ILENE | ||||||||
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| Credential: | AU.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13555 W MCDOWELL RD STE 209 | ||||||||
| Address2: | |||||||||
| City: | GOODYEAR | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853952628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235124199 | ||||||||
| FaxNumber: | 6235124176 | ||||||||
| Practice Location | |||||||||
| Address1: | 13555 W MCDOWELL RD STE 209 | ||||||||
| Address2: | |||||||||
| City: | GOODYEAR | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235124176 | ||||||||
| FaxNumber: | 6235124199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2008 | ||||||||
| LastUpdateDate: | 10/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | DA2030 | AZ | Y | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 856161 | 05 | AZ | MEDICAID |