Provider Demographics
NPI:1992811186
Name:DR ANNETTE ARZT SC
Entity type:Organization
Organization Name:DR ANNETTE ARZT SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARZT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:847-824-2686
Mailing Address - Street 1:960 RAND ROAD
Mailing Address - Street 2:SUITE 219A
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-2352
Mailing Address - Country:US
Mailing Address - Phone:847-824-2686
Mailing Address - Fax:847-838-5958
Practice Address - Street 1:960 RAND ROAD
Practice Address - Street 2:SUITE 219A
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-2352
Practice Address - Country:US
Practice Address - Phone:847-824-2686
Practice Address - Fax:847-838-5958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL936111Medicare PIN