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Individual

AMANDA FISHBACK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
800 W 5TH AVENUE SUITE 106 F/G, NAPERVILLE, IL 60563
(630) 639-1655
Mailing address
800 W 5TH AVENUE SUITE 106 F/G, NAPERVILLE, IL 60563
(630) 639-1655

Taxonomy

Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
F21200390838
IL

Other

Enumeration date
11/17/2010
Last updated
11/17/2010
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