Provider Demographics
NPI:1104507151
Name:FULK, ANN ELIZABETH (MSW)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:ELIZABETH
Last Name:FULK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:ANN
Other - Middle Name:ELIZABETH
Other - Last Name:FULK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:402 N MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-2214
Mailing Address - Country:US
Mailing Address - Phone:224-578-0380
Mailing Address - Fax:
Practice Address - Street 1:1860 W WINCHESTER RD STE 106
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5312
Practice Address - Country:US
Practice Address - Phone:847-816-6335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker