Provider Demographics
NPI:1558619072
Name:MAY, ANNETTE (MSW, LSW, CAPSW)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:MAY
Suffix:
Gender:F
Credentials:MSW, LSW, CAPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2272
Mailing Address - Country:US
Mailing Address - Phone:815-227-9002
Mailing Address - Fax:815-227-9070
Practice Address - Street 1:4920 E STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2272
Practice Address - Country:US
Practice Address - Phone:815-227-9002
Practice Address - Fax:815-227-9070
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150013275104100000X
WI128663-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker