Healthcare Provider Details

I. General information

NPI: 1649188111
Provider Name (Legal Business Name): SANDRA RODRIGUEZ
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 LANDWEHR RD
NORTHBROOK IL
60062-2309
US

IV. Provider business mailing address

605 LANDWEHR RD
NORTHBROOK IL
60062-2309
US

V. Phone/Fax

Practice location:
  • Phone: 224-723-5772
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number178020648
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: