Healthcare Provider Details

I. General information

NPI: 1215471693
Provider Name (Legal Business Name): ANNE RODGERS-SULLIVAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2016
Last Update Date: 12/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 N HIGHLAND AVE
AURORA IL
60506-1401
US

IV. Provider business mailing address

1230 N HIGHLAND AVE
AURORA IL
60506-1401
US

V. Phone/Fax

Practice location:
  • Phone: 630-966-4300
  • Fax: 630-859-2994
Mailing address:
  • Phone: 630-966-4348
  • Fax: 630-859-2994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.018747
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: