| The Black Sheep Sanctuary Pllc | |
|
3080 Ogden Ave Ste 104 Lisle IL 60532-1693 | |
| (630) 423-6244 | |
| Not Available |
| Full Name | The Black Sheep Sanctuary Pllc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 3080 Ogden Ave Ste 104, Lisle, Illinois |
| Authorized Official Name and Position | Samantha Vanderplow (MANAGER) |
| Authorized Official Contact | 6307091471 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Black Sheep Sanctuary Pllc 136 Terrace Dr Dekalb IL 60115-1936 Ph: (630) 709-1471 | The Black Sheep Sanctuary Pllc 3080 Ogden Ave Ste 104 Lisle IL 60532-1693 Ph: (630) 423-6244 |
| NPI Number | 1457159386 |
|---|---|
| Provider Enumeration Date | 03/06/2025 |
| Last Update Date | 04/02/2025 |
| Certification Date | 04/02/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457159386 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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