Provider Demographics
NPI:1013226950
Name:VAHLE, ANNE-CLAIRE MARIE (MSED)
Entity Type:Individual
Prefix:MRS
First Name:ANNE-CLAIRE
Middle Name:MARIE
Last Name:VAHLE
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:MS
Other - First Name:ANNE-CLAIRE
Other - Middle Name:MARIE
Other - Last Name:WALRATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2228 S SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62305-8981
Mailing Address - Country:US
Mailing Address - Phone:217-440-4982
Mailing Address - Fax:
Practice Address - Street 1:205 S 24TH ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-4446
Practice Address - Country:US
Practice Address - Phone:217-222-0034
Practice Address - Fax:217-222-3865
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.006346101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional