Individual
AMANDA THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
641 W 63RD ST, CHICAGO, IL 60621-2032
(312) 747-7496
(312) 747-3674
Mailing address
333 S STATE ST, CHICAGO, IL 60604-3900
(312) 747-9545
(312) 747-3674
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
101YP2500X
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
366005820066
—
IL
Enumeration date
10/16/2013
Last updated
10/16/2013
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