Healthcare Provider Details

I. General information

NPI: 1164188801
Provider Name (Legal Business Name): ANNE ELIZABETH GLASSGOW PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 S MICHIGAN AVE
CHICAGO IL
60616-2857
US

IV. Provider business mailing address

PO BOX 185
ELMHURST IL
60126-0185
US

V. Phone/Fax

Practice location:
  • Phone: 312-949-9199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149010007
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: