Healthcare Provider Details

I. General information

NPI: 1114200060
Provider Name (Legal Business Name): ANNE LOUISE REDLICH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2011
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N MICHIGAN AVE SUITE 1819
CHICAGO IL
60602-3402
US

IV. Provider business mailing address

30 N MICHIGAN AVE SUITE 1819
CHICAGO IL
60602-3402
US

V. Phone/Fax

Practice location:
  • Phone: 312-849-4980
  • Fax:
Mailing address:
  • Phone: 312-849-4980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number149002632
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: