Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 071007604 | IL |
Y | 103T00000X | Psychologist | 071007604 | IL |
N | 103G00000X | Clinical Psychologist | 071007604 | IL |
N | 103TC0700X | Clinical Psychologist | 071007604 | IL |
NPI | 1003054339 |
---|---|
Provider Name | Dr. Amber D Bauer-Gambla |
First Address | Chicago, IL 60602 |
Second Address | Chicago, IL 60602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2009 |
Last Update Date | 16/02/2010 |