Healthcare Provider Details

I. General information

NPI: 1134732860
Provider Name (Legal Business Name): ANYA RYDER WEBER MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 EDWARDS ST
ALTON IL
62002-3915
US

IV. Provider business mailing address

902 W MAIN ST
WEST FRANKFORT IL
62896-2210
US

V. Phone/Fax

Practice location:
  • Phone: 618-462-2331
  • Fax: 618-462-2504
Mailing address:
  • Phone: 618-937-6483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.02505
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: