Provider Demographics
NPI:1326209917
Name:RIISMAA, ANNELI (LP)
Entity Type:Individual
Prefix:DR
First Name:ANNELI
Middle Name:
Last Name:RIISMAA
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:ANNELI
Other - Middle Name:
Other - Last Name:RAUD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1325 REMINGTON RD.
Mailing Address - Street 2:SUITE R
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173
Mailing Address - Country:US
Mailing Address - Phone:646-483-6819
Mailing Address - Fax:
Practice Address - Street 1:1325 REMINGTON RD.
Practice Address - Street 2:SUITE R
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173
Practice Address - Country:US
Practice Address - Phone:646-483-6819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
IL071.008881103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL870299862OtherLDSFS