Most Relevant Information
Provider Data
| NPI Number: | 1003412529 |
| Provider Name: | AMANDA MEAD |
| Entity Type: | Individual |
| Taxonomy Code: | 101YP2500X |
| Specialty: | Counselor |
| License Number: | 178015815 |
Most Important Dates
| Enumeration Date: | 12/09/2020 |
| Last Updated: | 12/09/2020 |
Provider Practice Location
320 S CORNELL AVE STE B
VILLA PARK
IL
601815717
Practice Location Phone/Fax
| Phone: | 7088459902 |
| Fax: |
Provider Mailing Location
203 N BONNIE BRAE AVE
ELMHURST
IL
601262569
Provider Mailing Phone/Fax
| Phone: | 7088459902 |
| Fax: |