Healthcare Provider Details

I. General information

NPI: 1154576452
Provider Name (Legal Business Name): RITA L SANDERS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 N VINE ST UNIT 201
NEW LENOX IL
60451-1652
US

IV. Provider business mailing address

305 N VINE ST UNIT 201
NEW LENOX IL
60451-1652
US

V. Phone/Fax

Practice location:
  • Phone: 815-258-9733
  • Fax: 815-320-3825
Mailing address:
  • Phone: 815-258-9733
  • Fax: 815-320-3825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.007398
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.007398
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: