Healthcare Provider Details

I. General information

NPI: 1427146620
Provider Name (Legal Business Name): ANNE P MAXWELL PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 RIDGE AVE 315 BURCH HALL
EVANSTON IL
60201-1718
US

IV. Provider business mailing address

2650 RIDGE AVE 315 BURCH HALL
EVANSTON IL
60201-1718
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-2577
  • Fax: 847-570-2073
Mailing address:
  • Phone: 847-570-2577
  • Fax: 847-570-2073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: