MEDICARE: JILL AMICO MA, LLPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	6401007372	MI

General Provider Information

NPI Number	:	1457874281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL AMICO MA, LLPC

Provider Business Mailing Address
First Line	:	805 OAKWOOD DR STE 210
Second Line	:
City	:	ROCHESTER
State	:	MI
Zip	:	48307-1359
Country	:	US
Telephone Number	:	248-495-0977
Fax Number	:

Provider Business Practice Location Address
First Line	:	805 OAKWOOD DR STE 210
Second Line	:
City	:	ROCHESTER
State	:	MI
Zip	:	48307-1359
Country	:	US
Telephone Number	:	248-495-0977
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2017
Last Update Date	:	12/04/2023

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