Individual
DR. ROSE ANN ILLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
2780 CLEVELAND AVE, SUITE 709, FORT MYERS, FL 33901
(239) 343-3831
(239) 343-2301
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-3831
(239) 343-2301
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY8790
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100457900
—
FL
Enumeration date
08/26/2008
Last updated
03/25/2021
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