Provider Demographics
NPI:1346775830
Name:LETOURNEAU, ANN MICHELLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:MICHELLE
Last Name:LETOURNEAU
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 THORNHILL DR
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-2706
Mailing Address - Country:US
Mailing Address - Phone:630-752-9750
Mailing Address - Fax:
Practice Address - Street 1:507 THORNHILL DR
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-2706
Practice Address - Country:US
Practice Address - Phone:630-752-9750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-22
Last Update Date:2017-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.009537103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical