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General NPI Number Information
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NPI Number | 1225697956
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Entity Type | Individual
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Provider Name | JOSEPH JAMES SANDERS MSW, LCSW
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Gender | Male
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Dates
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Enumeration Date | 06/06/2019
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Last Update Date | 06/06/2019
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Provider Practice Location Address
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Address Line | 5888 N RIDGE AVE
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City | CHICAGO
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State | IL
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Zip | 60660-3450
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Country | US
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Telephone | 248-420-0162
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Fax |
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Provider Business Mailing Address
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Address Line | 26157 W ROLLINS RD
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City | INGLESIDE
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State | IL
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Zip | 60041-8530
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Country | US
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Telephone | 847-791-4659
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149007093
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License Number State | IL
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