Healthcare Provider Details

I. General information

NPI: 1194536268
Provider Name (Legal Business Name): ROSEMARY SANDERS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N MICHIGAN AVE
CHICAGO IL
60601-3901
US

IV. Provider business mailing address

7207 S SAINT LAWRENCE AVE
CHICAGO IL
60619-1707
US

V. Phone/Fax

Practice location:
  • Phone: 312-815-9660
  • Fax:
Mailing address:
  • Phone: 773-738-2480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.021143
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: