Provider Demographics
NPI:1033662846
Name:SANDERS, VICTORIA ROBERTS (MS, CGC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ROBERTS
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CGC
Mailing Address - Street 1:225 E CHICAGO AVE
Mailing Address - Street 2:BOX 59
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2991
Mailing Address - Country:US
Mailing Address - Phone:312-227-6120
Mailing Address - Fax:312-227-9413
Practice Address - Street 1:225 E CHICAGO AVE
Practice Address - Street 2:BOX 59
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:312-227-6120
Practice Address - Fax:312-227-9413
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL246000052170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS