Provider Demographics
NPI:1598926578
Name:MAXWELL, ABIGAIL ANN
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:ANN
Last Name:MAXWELL
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 1:318 6TH AVE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:ROCHELLE
Mailing Address - State:IL
Mailing Address - Zip Code:61068-1635
Mailing Address - Country:US
Mailing Address - Phone:630-975-1097
Mailing Address - Fax:
Practice Address - Street 1:1321 N 7TH ST
Practice Address - Street 2:
Practice Address - City:ROCHELLE
Practice Address - State:IL
Practice Address - Zip Code:61068-1185
Practice Address - Country:US
Practice Address - Phone:815-562-3801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490130581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical