Individual
AMANDA LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5 REVERE DR STE 120, NORTHBROOK, IL 60062-8005
(847) 807-6647
Mailing address
5 REVERE DR STE 120, NORTHBROOK, IL 60062-8005
(847) 807-6647
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-20-149685
IL
Other
Enumeration date
01/27/2021
Last updated
01/27/2021
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