Provider Demographics
NPI:1326793357
Name:TESS, ANNA (EDD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:TESS
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 LINCOLN AVE APT 2B
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-2526
Mailing Address - Country:US
Mailing Address - Phone:708-227-4037
Mailing Address - Fax:
Practice Address - Street 1:108 LINCOLN AVE APT 2B
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-2526
Practice Address - Country:US
Practice Address - Phone:708-227-4037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist