Provider Demographics
NPI:1851493035
Name:DODDS, SONDRA SUE (LCSW)
Entity Type:Individual
Prefix:
First Name:SONDRA
Middle Name:SUE
Last Name:DODDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 HAVEN RD
Mailing Address - Street 2:UNIT 5
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126
Mailing Address - Country:US
Mailing Address - Phone:630-782-6268
Mailing Address - Fax:630-782-6268
Practice Address - Street 1:103 HAVEN ROAD
Practice Address - Street 2:UNIT 5
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126
Practice Address - Country:US
Practice Address - Phone:630-782-6268
Practice Address - Fax:630-782-6268
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490039411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL984661Medicare ID - Type Unspecified