Provider Demographics
NPI:1093131906
Name:POLER, ANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:POLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 PARK LANE
Mailing Address - Street 2:
Mailing Address - City:GOLF
Mailing Address - State:IL
Mailing Address - Zip Code:60029
Mailing Address - Country:US
Mailing Address - Phone:773-727-2643
Mailing Address - Fax:
Practice Address - Street 1:1634 N ROCKWELL ST
Practice Address - Street 2:1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-5218
Practice Address - Country:US
Practice Address - Phone:773-727-2643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-16
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0160091041C0700X
CO099249611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical