Healthcare Provider Details

I. General information

NPI: 1508695651
Provider Name (Legal Business Name): ANNA HERRIGES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 W POLK ST STE G15
CHICAGO IL
60605-2768
US

IV. Provider business mailing address

165 W SUPERIOR ST UNIT 907
CHICAGO IL
60654-3588
US

V. Phone/Fax

Practice location:
  • Phone: 312-431-8050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2845367
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: