Provider Demographics
NPI:1558640169
Name:KNOX, SANDRA CECILIA (LCPC)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:CECILIA
Last Name:KNOX
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 VERMONT ST
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-2714
Mailing Address - Country:US
Mailing Address - Phone:312-805-0189
Mailing Address - Fax:
Practice Address - Street 1:1715 VERMONT ST
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-2714
Practice Address - Country:US
Practice Address - Phone:312-805-0189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-12
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180001536101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional