Provider Demographics
NPI:1164903522
Name:SANCHEZ, EDGARD D (BA)
Entity Type:Individual
Prefix:
First Name:EDGARD
Middle Name:D
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 S MILLER ST UNIT 3B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-2979
Mailing Address - Country:US
Mailing Address - Phone:507-208-8959
Mailing Address - Fax:
Practice Address - Street 1:8707 SKOKIE BLVD STE 207
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2272
Practice Address - Country:US
Practice Address - Phone:847-673-8577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor