Provider Demographics
NPI:1467498451
Name:BLOOD, SANDRA LEE (MA, LCPC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:BLOOD
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:83 W MAIN ST
Mailing Address - Street 2:ROOM 202
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-6302
Mailing Address - Country:US
Mailing Address - Phone:847-438-9911
Mailing Address - Fax:847-438-9567
Practice Address - Street 1:1811 W DIEHL RD
Practice Address - Street 2:SUITE 700
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-9086
Practice Address - Country:US
Practice Address - Phone:630-983-0600
Practice Address - Fax:630-983-3590
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4932362OtherBLUE SHIELD OF IL NUMBER