Provider Demographics
NPI:1720871239
Name:WASSON, ANNA LAVENDER
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:LAVENDER
Last Name:WASSON
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 1:100 SAINT MARYS DR APT 3A
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946-3494
Mailing Address - Country:US
Mailing Address - Phone:618-638-8668
Mailing Address - Fax:
Practice Address - Street 1:100 SAINT MARYS DR APT 3A
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:IL
Practice Address - Zip Code:62946-3494
Practice Address - Country:US
Practice Address - Phone:618-638-8668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker