Provider Demographics
NPI:1669755310
Name:SENDIC, SHOSHANA SARAH
Entity type:Individual
Prefix:MRS
First Name:SHOSHANA
Middle Name:SARAH
Last Name:SENDIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 W GREENLEAF AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-3014
Mailing Address - Country:US
Mailing Address - Phone:646-266-5635
Mailing Address - Fax:
Practice Address - Street 1:2708 W GREENLEAF AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-3014
Practice Address - Country:US
Practice Address - Phone:646-266-5635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020328-1235Z00000X
IL146.010852235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist