Provider Demographics
NPI:1679602809
Name:ANNE CHODZKO PC
Entity Type:Organization
Organization Name:ANNE CHODZKO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHODZKO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:847-433-0810
Mailing Address - Street 1:991 DEERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3569
Mailing Address - Country:US
Mailing Address - Phone:847-433-0810
Mailing Address - Fax:773-751-2250
Practice Address - Street 1:636 CHURCH ST
Practice Address - Street 2:SUITE 701
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4508
Practice Address - Country:US
Practice Address - Phone:847-926-9487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00276349OtherRAILROAD MEDICARE