Provider Demographics
NPI:1013016161
Name:MOTT, ANN DOURLET (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:DOURLET
Last Name:MOTT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E NORTHWEST HWY
Mailing Address - Street 2:SUITE 407
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074
Mailing Address - Country:US
Mailing Address - Phone:847-604-4140
Mailing Address - Fax:
Practice Address - Street 1:800 E NORTHWEST HWY
Practice Address - Street 2:SUITE 407
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074
Practice Address - Country:US
Practice Address - Phone:847-604-4140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004004103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL227920Medicare ID - Type Unspecified