Provider Demographics
NPI:1588700348
Name:CHATWOOD, SANDRA KAY (MA LMFT LCPC)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:KAY
Last Name:CHATWOOD
Suffix:
Gender:F
Credentials:MA LMFT LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709 N ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:61616
Mailing Address - Country:US
Mailing Address - Phone:309-668-0025
Mailing Address - Fax:309-688-0073
Practice Address - Street 1:3709 N ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:PEORIA HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:61616
Practice Address - Country:US
Practice Address - Phone:309-668-0025
Practice Address - Fax:309-688-0073
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist