Healthcare Provider Details

I. General information

NPI: 1558871483
Provider Name (Legal Business Name): SANDRA BUECKER SPEARS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2017
Last Update Date: 10/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E HURON ST
CHICAGO IL
60611-2999
US

IV. Provider business mailing address

333 N MICHIGAN AVE STE 1900
CHICAGO IL
60601-3994
US

V. Phone/Fax

Practice location:
  • Phone: 312-898-1289
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number149.019605
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: