Provider Demographics
NPI:1336526995
Name:ANNEX, JOSHUA
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:ANNEX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4157 N CLARENDON AVE
Mailing Address - Street 2:APT 206
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2268
Mailing Address - Country:US
Mailing Address - Phone:917-520-1614
Mailing Address - Fax:
Practice Address - Street 1:4157 N CLARENDON AVE
Practice Address - Street 2:APT 206
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2268
Practice Address - Country:US
Practice Address - Phone:917-520-1614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0174101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical