Healthcare Provider Details

I. General information

NPI: 1447707724
Provider Name (Legal Business Name): MARY SANDLER PHMNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2016
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 N SAINT CLAIR ST STE 1100
CHICAGO IL
60611-2954
US

IV. Provider business mailing address

676 N SAINT CLAIR ST STE 1100
CHICAGO IL
60611-2954
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-5060
  • Fax:
Mailing address:
  • Phone: 312-695-5060
  • Fax: 312-695-5010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209034449
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178011747
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: