Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | ||
N | 103TC0700X | Clinical Psychologist | ||
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist | ||
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
Y | 103G00000X | Clinical Psychologist | 071-007847 | IL |
Y | 103TC0700X | Clinical Psychologist | 071-007847 | IL |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | ||
N | 103TS0200X | School Psychologist | 235591 | IL |
NPI | 1174776447 |
---|---|
Provider Name | Dr. Tiffany Devica Sanders |
First Address | Oak Park, IL 60302-1257 |
Second Address | Westchester, IL 60154-5814 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2008 |
Last Update Date | 03/06/2016 |