Provider Demographics
NPI:1508082348
Name:FRENTZOS, ANNE DOUGLAS
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:DOUGLAS
Last Name:FRENTZOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26W465 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1161
Mailing Address - Country:US
Mailing Address - Phone:630-752-8621
Mailing Address - Fax:
Practice Address - Street 1:3033 OGDEN AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1673
Practice Address - Country:US
Practice Address - Phone:630-527-1664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health