Provider Demographics
NPI:1356316624
Name:WHITE, ANN P (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:P
Last Name:WHITE
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 1:6620 N GLENWOOD AVE
Mailing Address - Street 2:#2S
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-4787
Mailing Address - Country:US
Mailing Address - Phone:773-743-5359
Mailing Address - Fax:
Practice Address - Street 1:444 N NORTHWEST HWY
Practice Address - Street 2:145
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-3263
Practice Address - Country:US
Practice Address - Phone:847-685-9900
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
L95035Medicare ID - Type Unspecified