Provider Demographics
NPI:1174975155
Name:AERTS, ILSE
Entity type:Individual
Prefix:
First Name:ILSE
Middle Name:
Last Name:AERTS
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 1:6649 AMETHYST AVE UNIT 8878
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-1540
Mailing Address - Country:US
Mailing Address - Phone:909-736-0088
Mailing Address - Fax:
Practice Address - Street 1:3633 INLAND EMPIRE BLVD STE 777
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-7974
Practice Address - Country:US
Practice Address - Phone:909-295-5805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-01
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6135101YP2500X
CA96211106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional