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General NPI Number Information
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NPI Number | 1548915523
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Entity Type | Individual
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Provider Name | SANDRA PAHNKE
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Gender | Female
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Dates
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Enumeration Date | 02/17/2022
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Last Update Date | 07/19/2024
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Provider Practice Location Address
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Address Line | 2285 SEQUOIA DR
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City | AURORA
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State | IL
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Zip | 60506-6209
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Country | US
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Telephone | 630-906-5120
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Fax | 630-906-5093
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Provider Business Mailing Address
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Address Line | 28594 NETWORK PL
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City | CHICAGO
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State | IL
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Zip | 60673-1285
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Country | US
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Telephone | 630-859-6800
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 5003
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.010674
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License Number State | IL
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