Provider Demographics
NPI:1194267013
Name:RANES, PHYLICIA
Entity type:Individual
Prefix:
First Name:PHYLICIA
Middle Name:
Last Name:RANES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 PIERCE RD
Mailing Address - Street 2:
Mailing Address - City:ITASSCA
Mailing Address - State:IL
Mailing Address - Zip Code:60143
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:333 PIERCE RD
Practice Address - Street 2:
Practice Address - City:ITASSCA
Practice Address - State:IL
Practice Address - Zip Code:60143
Practice Address - Country:US
Practice Address - Phone:630-773-1985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.011653101YP2500X
IL208.000488106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist