Provider Demographics
NPI:1083352629
Name:KOGAN, SANDRA GRACE (MS)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:GRACE
Last Name:KOGAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N MILWAUKEE AVE APT 603
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-3086
Mailing Address - Country:US
Mailing Address - Phone:847-809-5368
Mailing Address - Fax:
Practice Address - Street 1:960 STATE ROUTE 22 STE 216
Practice Address - Street 2:
Practice Address - City:FOX RIVER GROVE
Practice Address - State:IL
Practice Address - Zip Code:60021-1955
Practice Address - Country:US
Practice Address - Phone:224-219-1924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist