Provider Demographics
NPI:1285002287
Name:ERICKA AXNESS, LCSW AND ASSOCIATES, LLC
Entity Type:Organization
Organization Name:ERICKA AXNESS, LCSW AND ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ERICKA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:AXNESS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-864-0671
Mailing Address - Street 1:129 FAIRFIELD WAY
Mailing Address - Street 2:303A
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1560
Mailing Address - Country:US
Mailing Address - Phone:630-864-0671
Mailing Address - Fax:630-597-2541
Practice Address - Street 1:129 FAIRFIELD WAY
Practice Address - Street 2:303A
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1560
Practice Address - Country:US
Practice Address - Phone:630-864-0671
Practice Address - Fax:630-597-2541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490110741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty