Healthcare Provider Details

I. General information

NPI: 1528271582
Provider Name (Legal Business Name): LESTER AND ROSALIE ANIXTER CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 05/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 N CLYBOURN AVE SECOND FLOOR
CHICAGO IL
60614-4036
US

IV. Provider business mailing address

6610 N CLARK ST FIRST FLOOR
CHICAGO IL
60626-4062
US

V. Phone/Fax

Practice location:
  • Phone: 773-761-1501
  • Fax: 773-977-1240
Mailing address:
  • Phone: 773-761-1501
  • Fax: 773-977-1240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: MARY DESMOND
Title or Position: SENIOR DIRECTOR OF FINANCE
Credential:
Phone: 773-761-1501