Provider Demographics
NPI:1497034961
Name:SANDERS, KIMBERLY LATRICE (PSYD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:LATRICE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:LATRICE
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:3034 RICHTON PL
Mailing Address - Street 2:
Mailing Address - City:RICHTON PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60471-1321
Mailing Address - Country:US
Mailing Address - Phone:630-286-9635
Mailing Address - Fax:
Practice Address - Street 1:3034 RICHTON PL
Practice Address - Street 2:
Practice Address - City:RICHTON PARK
Practice Address - State:IL
Practice Address - Zip Code:60471-1321
Practice Address - Country:US
Practice Address - Phone:630-286-9635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71.008142103TC0700X
IL071.008142103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical