Provider Demographics
NPI:1205005675
Name:SANDER, LAURIE BETH (MHP)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:BETH
Last Name:SANDER
Suffix:
Gender:F
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4409 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62305-5849
Mailing Address - Country:US
Mailing Address - Phone:217-223-0423
Mailing Address - Fax:217-223-0461
Practice Address - Street 1:4409 MAINE ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62305-5849
Practice Address - Country:US
Practice Address - Phone:217-223-0423
Practice Address - Fax:217-223-0461
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor