Penelope A Andersen, LCSW,LMFT,MSW
Individual provider Active NPI Clinical Social Worker · Glen Ellyn, IL
NPI 1821167982 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1821167982
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 149009657 (IL)
- Practice address
- 516 N Main St Ste a
Glen Ellyn, IL 60137-5175 - Phone
- (630) 858-1075
- Fax
- (630) 858-5569
- NPI assigned
- Nov 6, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149009657 | IL | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149009657 | IL | Yes |
Addresses
Primary practice location
516 N Main St Ste a
Glen Ellyn, IL 60137-5175
Mailing address
910 Ellynwood Dr
Glen Ellyn, IL 60137-4218
Phone (630) 842-3423
Other providers in Glen Ellyn, IL
- Carla Amato-Martz
- Cynthia R Ambler
- John H Amendt Jr.
- American Drug Stores LLC
- Hafsa Amjed
- Edwin Anderson
- Jasmine Anish
- Anodyne Home Health LLC
- Anodyne Palliative Services LLC
- Asim Mohammad Ansari
All providers in Glen Ellyn, IL · Clinical Social Worker in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.