Provider Demographics
NPI:1700044724
Name:DE VERNEUIL, ANNE ELLEN (MA, CADC)
Entity Type:Individual
Prefix:
First Name:ANNE ELLEN
Middle Name:
Last Name:DE VERNEUIL
Suffix:
Gender:F
Credentials:MA, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5804 ELAINE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2435
Mailing Address - Country:US
Mailing Address - Phone:815-397-7654
Mailing Address - Fax:815-397-2712
Practice Address - Street 1:5804 ELAINE DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2435
Practice Address - Country:US
Practice Address - Phone:815-397-7654
Practice Address - Fax:815-397-2712
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178003248101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional