Healthcare Provider Details

I. General information

NPI: 1609914654
Provider Name (Legal Business Name): S. ANNE REDMOND L.C.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5412 N CLARK ST SOUTH SUITE
CHICAGO IL
60640-1223
US

IV. Provider business mailing address

3351 N RACINE AVE UNIT B
CHICAGO IL
60657-3238
US

V. Phone/Fax

Practice location:
  • Phone: 773-580-2940
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: