Provider Demographics
NPI:1720220320
Name:DIRL, CANNAE O (MSW)
Entity Type:Individual
Prefix:MS
First Name:CANNAE
Middle Name:O
Last Name:DIRL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 W HEALEY ST
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-3717
Mailing Address - Country:US
Mailing Address - Phone:217-398-8080
Mailing Address - Fax:
Practice Address - Street 1:1511 W HEALEY ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-3717
Practice Address - Country:US
Practice Address - Phone:217-390-3350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker