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NPI Code Detail

MEDICARE: MRS. SONJA RENEE BANDSTRA LCSW

MEDICARE: MRS. SONJA RENEE BANDSTRA LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerAPP-000916721OH
21041C0700XClinical Social Worker149012572IL
31041C0700XClinical Social Worker12265-123WI

General Provider Information

NPI Number : 1184892747
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SONJA RENEE BANDSTRA LCSW
Provider Business Mailing Address
First Line : 225 N MICHIGAN AVE STE 1430
Second Line :
City : CHICAGO
State : IL
Zip : 60601-7653
Country : US
Telephone Number : 312-971-3457
Fax Number : 224-204-9089
Provider Business Practice Location Address
First Line : 225 N MICHIGAN AVE STE 1430
Second Line :
City : CHICAGO
State : IL
Zip : 60601-7653
Country : US
Telephone Number : 312-971-3457
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/18/2008
Last Update Date : 04/16/2026

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