Provider Demographics
NPI:1225134778
Name:MCNELIS, ANNE MICHELLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:MICHELLE
Last Name:MCNELIS
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:PO BOX 4238
Mailing Address - Street 2:805 19TH ST
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61204
Mailing Address - Country:US
Mailing Address - Phone:309-283-1201
Mailing Address - Fax:309-793-9053
Practice Address - Street 1:805 19TH ST
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61204
Practice Address - Country:US
Practice Address - Phone:309-283-1201
Practice Address - Fax:309-793-9053
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363153563004Medicaid