Provider Demographics
NPI:1063790749
Name:SANDOUKA, LOAY J (PSYD)
Entity type:Individual
Prefix:
First Name:LOAY
Middle Name:J
Last Name:SANDOUKA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1644 W COLONIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:IL
Mailing Address - Zip Code:60067-1207
Mailing Address - Country:US
Mailing Address - Phone:847-776-4500
Mailing Address - Fax:847-776-4724
Practice Address - Street 1:1644 W COLONIAL PKWY
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:IL
Practice Address - Zip Code:60067-1207
Practice Address - Country:US
Practice Address - Phone:847-776-4500
Practice Address - Fax:847-776-4724
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007931103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical