Healthcare Provider Details

I. General information

NPI: 1336002856
Provider Name (Legal Business Name): MRS. ADRIENNE REESE SANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6608 PASTURE SIDE TRL
MATTESON IL
60443-2970
US

IV. Provider business mailing address

6608 PASTURE SIDE TRL
MATTESON IL
60443-2970
US

V. Phone/Fax

Practice location:
  • Phone: 708-620-3370
  • Fax:
Mailing address:
  • Phone: 708-620-3370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: