Provider Demographics
NPI:1912581950
Name:HAGENBUCH, ANNE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:
Last Name:HAGENBUCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:FANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1141 BARBARY CT
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE
Mailing Address - State:IL
Mailing Address - Zip Code:61068-1001
Mailing Address - Country:US
Mailing Address - Phone:815-440-7536
Mailing Address - Fax:
Practice Address - Street 1:1141 BARBARY CT
Practice Address - Street 2:
Practice Address - City:ROCHELLE
Practice Address - State:IL
Practice Address - Zip Code:61068-1001
Practice Address - Country:US
Practice Address - Phone:309-509-5650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-06
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490231671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty