Provider Demographics
NPI:1720223340
Name:SHEILA A. BOENDER, INC
Entity Type:Organization
Organization Name:SHEILA A. BOENDER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOENDER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCPC
Authorized Official - Phone:708-602-9425
Mailing Address - Street 1:9721 165TH ST STE 23
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-4511
Mailing Address - Country:US
Mailing Address - Phone:708-602-9425
Mailing Address - Fax:708-460-0300
Practice Address - Street 1:9721 165TH ST STE 23
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-4511
Practice Address - Country:US
Practice Address - Phone:708-602-9425
Practice Address - Fax:708-460-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180003880261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)