Healthcare Provider Details

I. General information

NPI: 1114157401
Provider Name (Legal Business Name): CARRIE BUCHANAN SANDERS AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 07/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N CHILDRENS PLZ # 38
CHICAGO IL
60614-3363
US

IV. Provider business mailing address

2300 N CHILDRENS PLZ # 38
CHICAGO IL
60614-3363
US

V. Phone/Fax

Practice location:
  • Phone: 773-880-4318
  • Fax: 773-880-6618
Mailing address:
  • Phone: 773-880-4318
  • Fax: 773-880-6618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147001317
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: