Provider Demographics
NPI:1245615871
Name:ANDERSON, DANIELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:ANDERSON
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 1:2 AMERICAN WAY
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-4341
Mailing Address - Country:US
Mailing Address - Phone:847-742-3545
Mailing Address - Fax:847-742-3559
Practice Address - Street 1:2 AMERICAN WAY
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-4341
Practice Address - Country:US
Practice Address - Phone:847-742-3545
Practice Address - Fax:847-742-3559
Is Sole Proprietor?:No
Enumeration Date:2015-07-24
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0177141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147.017714Medicaid
IL147.017714Medicaid
IL149017714Medicare UPIN
IL149017714Medicare Oscar/Certification