Provider Demographics
NPI:1043043037
Name:TROTTER, ANNA KATHLEEN
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:KATHLEEN
Last Name:TROTTER
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 1:101 S MAIN ST APT 113
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-0029
Mailing Address - Country:US
Mailing Address - Phone:540-419-1099
Mailing Address - Fax:
Practice Address - Street 1:6860 N FRONTAGE RD STE A
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-7828
Practice Address - Country:US
Practice Address - Phone:331-210-9210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
12474482103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst