Healthcare Provider Details

I. General information

NPI: 1659706752
Provider Name (Legal Business Name): ANN HRUBY APN, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2013
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 LEE ST
DES PLAINES IL
60016-4539
US

IV. Provider business mailing address

333 N LOREL AVE
CHICAGO IL
60644-2444
US

V. Phone/Fax

Practice location:
  • Phone: 847-795-3100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209010691
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180006039
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: