Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 178015815 | IL |
NPI | 1003412529 |
---|---|
Provider Name | Amanda Mead |
First Address | Elmhurst, IL 60126-2569 |
Second Address | Villa Park, IL 60181-5717 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2020 |
Last Update Date | 09/12/2020 |