Individual
AMANDA LAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9620 S ROBERTS RD, HICKORY HILLS, IL 60457-2238
(312) 554-5578
Mailing address
9620 S ROBERTS RD, HICKORY HILLS, IL 60457-2238
(312) 554-5578
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
IL
106S00000X
Behavior Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
463122413
—
IL
Enumeration date
06/22/2017
Last updated
01/09/2023
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