Individual
SANDRA JUEL BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
2052 N CLEVELAND AVE, GARDEN SUITE, CHICAGO, IL 60614-4505
(773) 281-2225
(773) 281-2226
Mailing address
PO BOX 371, SHELL ROCK, IA 50670-0371
(773) 490-2259
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
006290
IA
225700000X
Massage Therapist
Primary
227.005112
IL
Other
Enumeration date
06/01/2015
Last updated
06/01/2015
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