Provider Demographics
NPI:1588342109
Name:IED, SANDY E (MBA)
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:E
Last Name:IED
Suffix:
Gender:F
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16W434 HONEYSUCKLE ROSE LN APT 116
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-6755
Mailing Address - Country:US
Mailing Address - Phone:708-733-9092
Mailing Address - Fax:
Practice Address - Street 1:16W434 HONEYSUCKLE ROSE LN APT 116
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-6755
Practice Address - Country:US
Practice Address - Phone:708-733-9092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist