Provider Demographics
NPI:1306191499
Name:ANIOLOWSKI, DIANE (LCSW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:ANIOLOWSKI
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 1:564 W RANDOLPH ST
Mailing Address - Street 2:SUITE 251
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-2218
Mailing Address - Country:US
Mailing Address - Phone:708-606-9431
Mailing Address - Fax:
Practice Address - Street 1:564 W RANDOLPH ST
Practice Address - Street 2:SUITE 251
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-2218
Practice Address - Country:US
Practice Address - Phone:708-606-9431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150013081104100000X
IL1490157361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker