Healthcare Provider Details

I. General information

NPI: 1942331277
Provider Name (Legal Business Name): CHRISTINE ANNE WASHO M.S., M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 REGENCY DR E STE A
SAVOY IL
61874-9312
US

IV. Provider business mailing address

1401 REGENCY DR E SUITE A
SAVOY IL
61874-9312
US

V. Phone/Fax

Practice location:
  • Phone: 217-239-1547
  • Fax:
Mailing address:
  • Phone: 217-239-1547
  • Fax: 217-239-2331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149-005305
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: