Provider Demographics
NPI:1235329541
Name:SANCHEZ, DAVID MATOS (CSAC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MATOS
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 W PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-5415
Mailing Address - Country:US
Mailing Address - Phone:920-993-9010
Mailing Address - Fax:
Practice Address - Street 1:5150 N 32ND ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-5400
Practice Address - Country:US
Practice Address - Phone:414-462-4697
Practice Address - Fax:414-462-8296
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10850-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)