Individual
MRS. SANDRA J FALLON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
4624 JOHNSON AVE, WESTERN SPRINGS, IL 60558
(708) 203-9845
(708) 246-3408
Mailing address
4624 JOHNSON AVE, WESTERN SPRINGS, IL 60558
(708) 203-9845
(708) 246-3408
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071005007
IL
163W00000X
Registered Nurse
041094355
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001635216
BCBS
IL
Enumeration date
08/31/2006
Last updated
07/30/2014
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