Provider Demographics
NPI:1649800244
Name:DUNN, SANDRA PATRICIA (MS ED, LCPC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:PATRICIA
Last Name:DUNN
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 1:6S331 4TH ST
Mailing Address - Street 2:
Mailing Address - City:EOLA
Mailing Address - State:IL
Mailing Address - Zip Code:60519-2003
Mailing Address - Country:US
Mailing Address - Phone:630-392-4714
Mailing Address - Fax:
Practice Address - Street 1:2124 OGDEN AVE STE 301
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7542
Practice Address - Country:US
Practice Address - Phone:630-392-4717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180015665101YM0800X
IL180.015665101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0000Medicaid