Individual
AMANDA N HERZOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1007 WILSHIRE CT, CHAMPAIGN, IL 61821-6934
(217) 493-2265
Mailing address
1007 WILSHIRE CT, CHAMPAIGN, IL 61821-6934
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
H622-0148-5785
IL
Other
Enumeration date
04/29/2008
Last updated
04/29/2008
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