Provider Demographics
NPI:1932343779
Name:WILLGOOSE, ANN MARIE (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:MARIE
Last Name:WILLGOOSE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 E HOLZHAUER DR
Mailing Address - Street 2:P.O. BOX 273
Mailing Address - City:NASHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62263-2055
Mailing Address - Country:US
Mailing Address - Phone:618-327-3348
Mailing Address - Fax:618-327-4477
Practice Address - Street 1:781 E HOLZHAUER DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:IL
Practice Address - Zip Code:62263-2055
Practice Address - Country:US
Practice Address - Phone:618-327-3348
Practice Address - Fax:618-327-4477
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.002487101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional