Individual
AMBER ELISE VICIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
21701 GOUGAR RD, NEW LENOX, IL 60451-1576
(815) 878-4835
Mailing address
21701 GOUGAR RD, NEW LENOX, IL 60451-1576
(815) 878-4835
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/11/2018
Last updated
06/29/2022
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