Active NPI
Sandra Mary Bednarz Petersen, LCPC
- Mental Health Counselor
- Aurora, IL
National Provider Identifier
1285171801
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 178012647
- Practice address
- 1900 Ogden Ave
Aurora, IL 60504-4273 - Phone
- (630) 256-8007
- NPI assigned
- Jan 20, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 178012647 | IL | Primary |
Addresses
Primary practice location
1900 Ogden Ave
Aurora, IL 60504-4273
Mailing address
115 Queenswood Rd
Bolingbrook, IL 60440-2517
Phone (630) 532-2793
Other practice location 1
18100 W Oak Ave
Lockport, IL 60441-6125
Phone (815) 774-0327
Other names 1
- Sandra Mary Bednarz
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178012647 | IL | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Counseling Works | Past | Accepting new patients | |
| Trinity Services Inc. | Mental Health | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Professional Counselor
- Naperville, IL
- NPI 1477847945
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1484870400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557705600000",
"number": "1285171801",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 QUEENSWOOD RD",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604402517",
"telephone_number": "630-532-2793"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1900 OGDEN AVE",
"city": "AURORA",
"state": "IL",
"postal_code": "605044273",
"telephone_number": "630-256-8007"
}
],
"practiceLocations": [
{
"address_1": "18100 W Oak Ave",
"address_purpose": "LOCATION",
"city": "Lockport",
"state": "IL",
"postal_code": "604416125",
"country_code": "US",
"telephone_number": "815-774-0327",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PETERSEN",
"first_name": "SANDRA",
"middle_name": "MARY BEDNARZ",
"credential": "LCPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-01-20",
"last_updated": "2019-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IL",
"license": "178012647",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SANDRA",
"last_name": "BEDNARZ",
"middle_name": "MARY",
"credential": "LCPC",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Aurora, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.