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General NPI Number Information
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NPI Number | 1427678879
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Entity Type | Individual
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Provider Name | TAYLOR LYNN SANDENO
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Gender | Female
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Dates
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Enumeration Date | 04/25/2020
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Last Update Date | 04/25/2020
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Provider Practice Location Address
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Address Line | 304 W MONDAMIN ST STE 104
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City | MINOOKA
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State | IL
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Zip | 60447-4618
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Country | US
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Telephone | 815-557-8442
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Fax |
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Provider Business Mailing Address
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Address Line | 5540 E BAY VIEW DR
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City | MORRIS
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State | IL
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Zip | 60450-9790
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Country | US
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Telephone | 815-557-8442
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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