Healthcare Provider Details

I. General information

NPI: 1225848849
Provider Name (Legal Business Name): ANNA MAE SHRIVER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MAE SHRIVER

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 WOLF CREEK DR STE 100
SWANSEA IL
62226-2314
US

IV. Provider business mailing address

12 WOLF CREEK DR STE 100
SWANSEA IL
62226-2314
US

V. Phone/Fax

Practice location:
  • Phone: 844-850-4569
  • Fax: 772-264-3838
Mailing address:
  • Phone: 844-850-4569
  • Fax: 772-264-3838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number2647453
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberTPSW6358
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.024844
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: