Provider Demographics
NPI:1568568624
Name:ROTTER, ANN M (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:M
Last Name:ROTTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 BAY SCOTT CIR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-1114
Mailing Address - Country:US
Mailing Address - Phone:630-305-0464
Mailing Address - Fax:
Practice Address - Street 1:691 N BRIDGE ST
Practice Address - Street 2:SUITE A
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-1104
Practice Address - Country:US
Practice Address - Phone:630-305-0464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006394103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL215383Medicare PIN