Provider Demographics
NPI:1144414715
Name:VENDEN, SANDRA LEE REINKE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:LEE REINKE
Last Name:VENDEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1088
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-1088
Mailing Address - Country:US
Mailing Address - Phone:847-365-3322
Mailing Address - Fax:
Practice Address - Street 1:420 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:LAKE VILLA
Practice Address - State:IL
Practice Address - Zip Code:60046-8664
Practice Address - Country:US
Practice Address - Phone:847-365-3322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71007100103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical