Individual
AMANDA JUNE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
204 SOUTH ST, ANNA, IL 62906-1549
(618) 833-8551
(618) 833-2911
Mailing address
PO BOX 548, ANNA, IL 62906-0548
(618) 833-8551
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149014680
IL
Other
Enumeration date
10/11/2016
Last updated
10/11/2016
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