Provider Demographics
NPI:1407927056
Name:JANOWSKI, SANDRA AGNES (LCSW, CADC)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:AGNES
Last Name:JANOWSKI
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 JEFFERSON ST
Mailing Address - Street 2:UNIT 304
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-4485
Mailing Address - Country:US
Mailing Address - Phone:847-375-9479
Mailing Address - Fax:
Practice Address - Street 1:1480 JEFFERSON ST
Practice Address - Street 2:UNIT 304
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-4485
Practice Address - Country:US
Practice Address - Phone:847-375-9479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0102071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635360OtherBLUE CROSS BLUE SHIELD
IL212011Medicare PIN