Provider Demographics
NPI:1477424067
Name:UNDERWOOD, SANDRA D
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:D
Last Name:UNDERWOOD
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 W CHESTNUT ST UNIT 1406
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-3024
Mailing Address - Country:US
Mailing Address - Phone:312-972-5277
Mailing Address - Fax:
Practice Address - Street 1:770 N LASALLE STREET
Practice Address - Street 2:STE 800
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654
Practice Address - Country:US
Practice Address - Phone:773-908-9985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
IL227019016225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist