Healthcare Provider Details

I. General information

NPI: 1174063614
Provider Name (Legal Business Name): HEIDI ANNE AZARELA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 MERCY DR
MCHENRY IL
60050-3151
US

IV. Provider business mailing address

3901 MERCY DR
MCHENRY IL
60050-3151
US

V. Phone/Fax

Practice location:
  • Phone: 815-344-1230
  • Fax:
Mailing address:
  • Phone: 844-599-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.030312
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: