Provider Demographics
NPI:1649581984
Name:HUND-WANTLAND, ANITA ROSE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:ROSE
Last Name:HUND-WANTLAND
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 1:1601 CORONADO DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-7017
Mailing Address - Country:US
Mailing Address - Phone:217-649-8735
Mailing Address - Fax:
Practice Address - Street 1:100 N CHESTNUT ST STE 243
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-4872
Practice Address - Country:US
Practice Address - Phone:217-649-8735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007646103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling