Provider Demographics
NPI:1821328386
Name:ANGER CLINIC
Entity Type:Organization
Organization Name:ANGER CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:KATOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:QHEIC
Authorized Official - Phone:312-263-0035
Mailing Address - Street 1:29 S LASALLE ST
Mailing Address - Street 2:STE. 825
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-1507
Mailing Address - Country:US
Mailing Address - Phone:312-263-0035
Mailing Address - Fax:312-727-0355
Practice Address - Street 1:29 S LASALLE ST
Practice Address - Street 2:STE. 825
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-1507
Practice Address - Country:US
Practice Address - Phone:312-263-0035
Practice Address - Fax:312-727-0355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL7956251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health