Provider Demographics
NPI:1942684766
Name:CANADE, SOPHIE ANN (ATR, LPC)
Entity type:Individual
Prefix:MS
First Name:SOPHIE
Middle Name:ANN
Last Name:CANADE
Suffix:
Gender:F
Credentials:ATR, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3522 W LYNDALE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3516
Mailing Address - Country:US
Mailing Address - Phone:641-691-1851
Mailing Address - Fax:
Practice Address - Street 1:1702 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3713
Practice Address - Country:US
Practice Address - Phone:641-691-1851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL221700000X221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist