Individual
MRS. AMANDA TATHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RBT-17-43450
Contact information
Practice address
621 S LOCUST AVE, FREEPORT, IL 61032-5028
(815) 541-2929
Mailing address
621 S LOCUST AVE, FREEPORT, IL 61032-5028
(815) 541-2929
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-17-43450
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RBT-17-43450
AUTISM HOME SUPPORT
IL
Enumeration date
05/08/2018
Last updated
05/08/2018
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