Provider Demographics
NPI:1912274374
Name:RAPPAPORT, ANNE (LCPC, CRC)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:
Last Name:RAPPAPORT
Suffix:
Gender:F
Credentials:LCPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4718 N ALBY RD
Mailing Address - Street 2:
Mailing Address - City:GODFREY
Mailing Address - State:IL
Mailing Address - Zip Code:62035-1958
Mailing Address - Country:US
Mailing Address - Phone:618-433-9000
Mailing Address - Fax:
Practice Address - Street 1:6201 W MAIN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-6870
Practice Address - Country:US
Practice Address - Phone:314-683-0785
Practice Address - Fax:618-348-6235
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-29
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004662101YP2500X
IL00038190225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor