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General NPI Number Information
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NPI Number | 1174975155
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Entity Type | Individual
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Provider Name | ILSE AERTS
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Gender | Female
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Dates
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Enumeration Date | 07/01/2016
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 3633 INLAND EMPIRE BLVD STE 777
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City | ONTARIO
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State | CA
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Zip | 91764-7974
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Country | US
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Telephone | 909-295-5805
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Fax |
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Provider Business Mailing Address
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Address Line | 6649 AMETHYST AVE UNIT 8878
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City | ALTA LOMA
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State | CA
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Zip | 91701-1540
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Country | US
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Telephone | 909-736-0088
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6135
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 96211
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License Number State | CA
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