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General NPI Number Information
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NPI Number | 1699572834
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Entity Type | Individual
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Provider Name | MATTHEW SANDERS
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Gender | Male
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Dates
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Enumeration Date | 02/26/2025
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 495 DEVONSHIRE DR
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City | CHAMPAIGN
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State | IL
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Zip | 61820-7295
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Country | US
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Telephone | 217-904-3035
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Fax |
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Provider Business Mailing Address
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Address Line | 607 RED BUD DR
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City | MAHOMET
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State | IL
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Zip | 61853-9655
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Country | US
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Telephone | 217-621-6441
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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 | 150116298
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License Number State | IL
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