Provider Demographics
NPI:1265852891
Name:GRANNEMAN, ANNA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:
Last Name:GRANNEMAN
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 1:1921 W BELLE PLAINE AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1828
Mailing Address - Country:US
Mailing Address - Phone:773-459-7410
Mailing Address - Fax:
Practice Address - Street 1:1921 W BELLE PLAINE AVE APT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1828
Practice Address - Country:US
Practice Address - Phone:773-459-7410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0161841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical