Individual
MRS. AMANDA LIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DT
Contact information
Practice address
25632 BARROW RD, MANHATTAN, IL 60442-6250
(773) 544-9928
Mailing address
10548 S SPRINGFIELD AVE, CHICAGO, IL 60655-3829
(708) 990-2988
(815) 531-0043
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
06/13/2013
Last updated
06/13/2013
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