Sandra Lee Reinke Venden, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

71007100 Issued in IL

Practice address

420 W Grand Ave
Lake Villa, IL 60046-8664

Phone

(847) 365-3322

NPI assigned

Aug 28, 2007

Last updated

Aug 31, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1188259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1188518400000",
    "number": "1144414715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1088",
            "city": "LAKE VILLA",
            "state": "IL",
            "postal_code": "600461088",
            "telephone_number": "847-365-3322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 W GRAND AVE",
            "city": "LAKE VILLA",
            "state": "IL",
            "postal_code": "600468664",
            "telephone_number": "847-365-3322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VENDEN",
        "first_name": "SANDRA",
        "middle_name": "LEE REINKE",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-28",
        "last_updated": "2007-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "71007100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Lake Villa, IL
• Providers in Lake Villa, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.