Provider Demographics
NPI:1306485529
Name:FLORES-RODRIGUEZ, SANDY (PHD, LCP, NCSP)
Entity type:Individual
Prefix:DR
First Name:SANDY
Middle Name:
Last Name:FLORES-RODRIGUEZ
Suffix:
Gender:F
Credentials:PHD, LCP, NCSP
Other - Prefix:DR
Other - First Name:SANDY
Other - Middle Name:
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, LCP, NCSP
Mailing Address - Street 1:7170 W GRAND AVE APT 3E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60707-2862
Mailing Address - Country:US
Mailing Address - Phone:773-203-9386
Mailing Address - Fax:
Practice Address - Street 1:7170 W GRAND AVE APT 3E
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60707-2862
Practice Address - Country:US
Practice Address - Phone:773-203-9386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.010203103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical