Provider Demographics
NPI:1811419799
Name:MALLING, SONDRA (LCPC)
Entity Type:Individual
Prefix:
First Name:SONDRA
Middle Name:
Last Name:MALLING
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 1:5350 N LINDER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-1327
Mailing Address - Country:US
Mailing Address - Phone:847-323-0883
Mailing Address - Fax:
Practice Address - Street 1:2653 W OGDEN AVE FL 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1647
Practice Address - Country:US
Practice Address - Phone:773-257-6672
Practice Address - Fax:773-257-5330
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010975101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional