Individual
AMY ELIZABETH PRUDENCIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1301 E. WALNUT STREET, CARBONDALE, IL 62901
(618) 457-3371
(618) 549-1608
Mailing address
1301 E WALNUT ST, CARBONDALE, IL 62901-5004
(618) 457-3371
(618) 549-1608
Taxonomy
Speciality
Code
Description
License number
State
1041S0200X
School Social Worker
Primary
149014863
IL
Other
Enumeration date
09/21/2017
Last updated
07/21/2022
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