Provider Demographics
NPI:1588712244
Name:ANDERSON, IRENE B (IRENE ANDERSON)
Entity type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:B
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:IRENE ANDERSON
Other - Prefix:MRS
Other - First Name:IRENE
Other - Middle Name:BOND
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:1300 W BELMONT AVE
Mailing Address - Street 2:#401
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3200
Mailing Address - Country:US
Mailing Address - Phone:773-697-6871
Mailing Address - Fax:773-880-1323
Practice Address - Street 1:1300 W BELMONT AVE
Practice Address - Street 2:#401
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3200
Practice Address - Country:US
Practice Address - Phone:773-697-6871
Practice Address - Fax:773-880-1323
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist