Provider Demographics
NPI:1568882173
Name:CZERNIAK, ANNA (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:CZERNIAK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:BALDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:2407 WILD CHERRY CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-6416
Mailing Address - Country:US
Mailing Address - Phone:630-251-9259
Mailing Address - Fax:
Practice Address - Street 1:2407 WILD CHERRY CT
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-6416
Practice Address - Country:US
Practice Address - Phone:630-251-9259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0165811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1558539718OtherNPI