Provider Demographics
NPI:1386283562
Name:LISZKA, ANNA
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:
Last Name:LISZKA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:LISZKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1700 JADENS WAY
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-4602
Mailing Address - Country:US
Mailing Address - Phone:773-526-2173
Mailing Address - Fax:
Practice Address - Street 1:5901 N PROSPECT RD STE 202
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4358
Practice Address - Country:US
Practice Address - Phone:888-428-7890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-05
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180014359101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional