Healthcare Provider Details

I. General information

NPI: 1477220234
Provider Name (Legal Business Name): DR. SANITA SAENGVILAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2021
Last Update Date: 08/27/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 MENARD AVE
MORTON GROVE IL
60053-3052
US

IV. Provider business mailing address

4960 SOMERTON DR
HOFFMAN ESTATES IL
60010-5626
US

V. Phone/Fax

Practice location:
  • Phone: 847-965-9040
  • Fax:
Mailing address:
  • Phone: 847-542-2384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1101286
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: