Individual
AMANDA MATOUSEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3436 N KENNICOTT AVE, ARLINGTON HTS, IL 60004-7814
(847) 952-7460
(847) 222-1754
Mailing address
150 E HURON ST, CHICAGO, IL 60611-2999
(312) 964-4682
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
150015319
IL
1041C0700X
Clinical Social Worker
Primary
149019050
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201543752
BLUE CROSS BLUE SHIELD
IL
Enumeration date
11/10/2016
Last updated
10/11/2017
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