Provider Demographics
NPI:1427678879
Name:SANDENO, TAYLOR LYNN
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:LYNN
Last Name:SANDENO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5540 E BAY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-9790
Mailing Address - Country:US
Mailing Address - Phone:815-557-8442
Mailing Address - Fax:
Practice Address - Street 1:304 W MONDAMIN ST STE 104
Practice Address - Street 2:
Practice Address - City:MINOOKA
Practice Address - State:IL
Practice Address - Zip Code:60447-4618
Practice Address - Country:US
Practice Address - Phone:815-557-8442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-25
Last Update Date:2020-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker