Provider Demographics
NPI:1710114194
Name:HOSTETTER, ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:
Last Name:HOSTETTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6528 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3539
Mailing Address - Country:US
Mailing Address - Phone:708-833-2104
Mailing Address - Fax:
Practice Address - Street 1:6528 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3539
Practice Address - Country:US
Practice Address - Phone:708-833-2104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0136221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical