Provider Demographics
NPI:1083047120
Name:FERNANDEZ, ANNIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANNIE
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ANNIE
Other - Middle Name:
Other - Last Name:FERNANDEZ-BARRERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3232 LAKE AVE STE 330
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1085
Practice Address - Country:US
Practice Address - Phone:847-318-9300
Practice Address - Fax:847-723-9441
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-009568103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL071-009568OtherLICENSE