Provider Demographics
NPI:1235240896
Name:NATHAN, ANNE M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:M
Last Name:NATHAN
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 1:175 OLDE HALF DAY ROAD
Mailing Address - Street 2:
Mailing Address - City:LINCOLNSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60069
Mailing Address - Country:US
Mailing Address - Phone:847-777-6922
Mailing Address - Fax:847-777-6923
Practice Address - Street 1:175 OLDE HALF DAY ROAD
Practice Address - Street 2:
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069
Practice Address - Country:US
Practice Address - Phone:847-777-6922
Practice Address - Fax:847-777-6923
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007663L103TC0700X
NJ35S100382800103TC0700X
IL071.007361103TC0700X
NJ355100382800103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA77938Medicare PIN
77938Medicare ID - Type Unspecified