Provider Demographics
NPI:1679610323
Name:KRICK, ANNE (PSYD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:KRICK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N BLANCHARD ST
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5810
Mailing Address - Country:US
Mailing Address - Phone:630-665-3155
Mailing Address - Fax:630-517-8653
Practice Address - Street 1:200 N BLANCHARD ST
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5810
Practice Address - Country:US
Practice Address - Phone:630-665-3155
Practice Address - Fax:630-517-8653
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-005562103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical