Provider Demographics
NPI:1720233216
Name:LAFRENTZ MUEHLFELT, ANNA MARIE
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:MARIE
Last Name:LAFRENTZ MUEHLFELT
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ANNA
Other - Middle Name:MARIE
Other - Last Name:LAFRENTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5147 1/2 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515
Mailing Address - Country:US
Mailing Address - Phone:630-971-9856
Mailing Address - Fax:630-971-9856
Practice Address - Street 1:5147 1/2 MAIN STREET
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515
Practice Address - Country:US
Practice Address - Phone:630-971-9856
Practice Address - Fax:630-971-9856
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.003255101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional