Healthcare Provider Details

I. General information

NPI: 1063006856
Provider Name (Legal Business Name): KRISTEN SANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
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 TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.017463
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178018659
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: