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General NPI Number Information
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NPI Number | 1285171801
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Entity Type | Individual
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Provider Name | SANDRA MARY BEDNARZ PETERSEN LCPC
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Gender | Female
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Dates
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Enumeration Date | 01/20/2017
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Last Update Date | 05/13/2019
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Provider Practice Location Address
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Address Line | 1900 OGDEN AVE
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City | AURORA
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State | IL
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Zip | 60504-4273
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Country | US
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Telephone | 630-256-8007
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Fax |
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Provider Business Mailing Address
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Address Line | 115 QUEENSWOOD RD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-2517
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Country | US
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Telephone | 630-532-2793
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 178012647
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License Number State | IL
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