Provider Demographics
NPI:1205994837
Name:KOERWITZ, ANGELA RENE' (LCPC)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:RENE'
Last Name:KOERWITZ
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62563-9534
Mailing Address - Country:US
Mailing Address - Phone:217-414-4428
Mailing Address - Fax:217-414-4428
Practice Address - Street 1:617 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:IL
Practice Address - Zip Code:62563-9534
Practice Address - Country:US
Practice Address - Phone:217-414-4428
Practice Address - Fax:217-414-4428
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-004014101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional