Provider Demographics
NPI:1427593268
Name:RODRIGUEZ-RADJA, SANDRA (LCPC)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:RODRIGUEZ-RADJA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:RODRIGUEZ RADJA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:9306 PARKSIDE AVE
Mailing Address - Street 2:OAK LAWN
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2339
Mailing Address - Country:US
Mailing Address - Phone:708-674-0422
Mailing Address - Fax:
Practice Address - Street 1:9306 PARKSIDE AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2339
Practice Address - Country:US
Practice Address - Phone:708-674-0422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-04
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178012652101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional