Provider Demographics
NPI:1477761781
Name:SANDERS, LAUREN MEREDITH
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MEREDITH
Last Name:SANDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 447
Mailing Address - Street 2:138 WEST DAVIS
Mailing Address - City:EQUALITY
Mailing Address - State:IL
Mailing Address - Zip Code:62934-0447
Mailing Address - Country:US
Mailing Address - Phone:618-534-4401
Mailing Address - Fax:
Practice Address - Street 1:1201 PINE ST
Practice Address - Street 2:
Practice Address - City:ELDORADO
Practice Address - State:IL
Practice Address - Zip Code:62930-1634
Practice Address - Country:US
Practice Address - Phone:618-273-3361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008309101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional