MEDICARE: XOCHITL SANDOVAL LCSW

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	1041C0700X	Clinical Social Worker	149.021828	IL

General Provider Information

NPI Number	:	1891191144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	XOCHITL SANDOVAL LCSW

Provider Business Mailing Address
First Line	:	4824 S KEDVALE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60632-4107
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2451 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-1509
Country	:	US
Telephone Number	:	708-769-0782
Fax Number	:

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

Provider Enumeration Date	:	11/14/2014
Last Update Date	:	05/28/2025

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