Provider Demographics
NPI:1447391966
Name:KENDRICK, SANDRA J (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:J
Last Name:KENDRICK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3257 W 83RD PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60652-3316
Mailing Address - Country:US
Mailing Address - Phone:773-785-5519
Mailing Address - Fax:
Practice Address - Street 1:8941 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-6132
Practice Address - Country:US
Practice Address - Phone:773-785-5519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-001950101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL742264000OtherAETNA
IL742264000OtherMAGELLAN
IL192541OtherCOMPSYCH