Provider Demographics
NPI:1013320522
Name:NELSON, ANNIE SHEA
Entity Type:Individual
Prefix:MISS
First Name:ANNIE
Middle Name:SHEA
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 N PULASKI RD
Mailing Address - Street 2:BUILDING C, 2ND FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-6007
Mailing Address - Country:US
Mailing Address - Phone:312-744-1906
Mailing Address - Fax:312-744-5568
Practice Address - Street 1:5801 N PULASKI RD
Practice Address - Street 2:BUILDING C, 2ND FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-6007
Practice Address - Country:US
Practice Address - Phone:312-744-1906
Practice Address - Fax:312-744-5568
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health