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General NPI Number Information
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NPI Number | 1568359057
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Entity Type | Individual
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Provider Name | SANDRA PEREZ AVILA LSW
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Gender |
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Dates
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Enumeration Date | 06/18/2025
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 475 RIVER BEND RD STE 400B
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City | NAPERVILLE
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State | IL
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Zip | 60540-5277
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Country | US
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Telephone | 708-416-6315
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Fax |
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Provider Business Mailing Address
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Address Line | 75 SHEFFIELD RD
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City | MONTGOMERY
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State | IL
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Zip | 60538-2422
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Country | US
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Telephone | 331-203-3419
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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 | 150112553
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License Number State | IL
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