Healthcare Provider Details

I. General information

NPI: 1972693133
Provider Name (Legal Business Name): MS. ANNIE W. KOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 GRANDSTAND PL
ELGIN IL
60123-6603
US

IV. Provider business mailing address

1845 GRANDSTAND PL
ELGIN IL
60123-6603
US

V. Phone/Fax

Practice location:
  • Phone: 847-695-0484
  • Fax: 847-695-1265
Mailing address:
  • Phone: 847-931-9314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149-006248
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: