Provider Demographics
NPI:1003144049
Name:LOSOFF, ANN M (PHD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:LOSOFF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8170 MCCORMICK BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2961
Mailing Address - Country:US
Mailing Address - Phone:847-673-0718
Mailing Address - Fax:
Practice Address - Street 1:8170 MCCORMICK BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-2961
Practice Address - Country:US
Practice Address - Phone:847-673-0718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-03
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-007747103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$Other071007747, LICENSE