Provider Demographics
NPI:1750753299
Name:KANE, ANNE-MARIE (EDD LCPC)
Entity type:Individual
Prefix:DR
First Name:ANNE-MARIE
Middle Name:
Last Name:KANE
Suffix:
Gender:F
Credentials:EDD LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 CRYSTAL POINT DR STE 3
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-1400
Mailing Address - Country:US
Mailing Address - Phone:224-209-1276
Mailing Address - Fax:
Practice Address - Street 1:610 CRYSTAL POINT DR STE 3
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-1400
Practice Address - Country:US
Practice Address - Phone:224-209-1276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-23
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004509101YP2500X
WI5915-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional