Healthcare Provider Details

I. General information

NPI: 1689113003
Provider Name (Legal Business Name): SAUNDRA PEGUES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2017
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8333 AUSTIN AVE
BURBANK IL
60459-2558
US

IV. Provider business mailing address

8333 AUSTIN AVE
BURBANK IL
60459-2558
US

V. Phone/Fax

Practice location:
  • Phone: 708-398-6530
  • Fax: 708-398-6531
Mailing address:
  • Phone: 708-398-6530
  • Fax: 708-398-6531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.012752
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: