Provider Demographics
NPI:1750425781
Name:HULEFELD, ANNETTE MARIE (DMIN, LCSW)
Entity type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:MARIE
Last Name:HULEFELD
Suffix:
Gender:F
Credentials:DMIN, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 N OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1254
Mailing Address - Country:US
Mailing Address - Phone:708-383-3444
Mailing Address - Fax:708-383-7152
Practice Address - Street 1:1235 N OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1254
Practice Address - Country:US
Practice Address - Phone:708-383-3444
Practice Address - Fax:708-383-7152
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0167112122OtherBLUE CROSS BLUE SHIELD PR