Individual
AMANDA DEANGELES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1280 W. WASHINGTON BLVD, CHICAGO, IL 60607-1930
(312) 624-8750
Mailing address
1280 W. WASHINGTON BLVD, CHICAGO, IL 60607-1930
(312) 624-8750
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
85-0484980
INSURANCE
IL
Enumeration date
11/29/2016
Last updated
11/29/2016
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