Provider Demographics
NPI:1851490742
Name:DEVAUD, ANNE MONIQUE (PSYD)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:MONIQUE
Last Name:DEVAUD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 W NORTH AVENUE
Mailing Address - Street 2:SUITE 306 GOTTLIEB MEMORIAL HOSPITAL
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160
Mailing Address - Country:US
Mailing Address - Phone:708-681-9210
Mailing Address - Fax:708-681-9280
Practice Address - Street 1:675 W NORTH AVENUE
Practice Address - Street 2:SUITE 306 GOTTLIEB MEMORIAL HOSPITAL
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160
Practice Address - Country:US
Practice Address - Phone:708-681-9210
Practice Address - Fax:708-681-9280
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
K27614Medicare ID - Type Unspecified