Provider Demographics
NPI:1619932324
Name:KAKACEK, SANDRA LEE (MS ED; LCPC)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LEE
Last Name:KAKACEK
Suffix:
Gender:F
Credentials:MS ED; LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42W959 EMPIRE RD
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-8202
Mailing Address - Country:US
Mailing Address - Phone:630-584-8409
Mailing Address - Fax:630-587-1338
Practice Address - Street 1:4N645 SCHOOL RD
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-6508
Practice Address - Country:US
Practice Address - Phone:630-587-1980
Practice Address - Fax:630-587-1338
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional