Basic Information
| Provider Information | |||||||||
| NPI: | 1679602809 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANNE CHODZKO PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 991 DEERFIELD RD | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600353569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474330810 | ||||||||
| FaxNumber: | 7737512250 | ||||||||
| Practice Location | |||||||||
| Address1: | 636 CHURCH ST | ||||||||
| Address2: | SUITE 701 | ||||||||
| City: | EVANSTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 602014508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479269487 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2007 | ||||||||
| LastUpdateDate: | 12/07/2007 | ||||||||
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| AuthorizedOfficialLastName: | CHODZKO | ||||||||
| AuthorizedOfficialFirstName: | ANNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CLINICAL PSYCHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 8474330810 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | P00276349 | 01 | IL | RAILROAD MEDICARE | OTHER |