MEDICARE: MRS. AMANDA ELLA RANKIN LCSW

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	1041C0700X	Clinical Social Worker	149.010860	IL

General Provider Information

NPI Number	:	1699028852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA ELLA RANKIN LCSW

Provider Business Mailing Address
First Line	:	1140 N MCLEAN BLVD STE I
Second Line	:
City	:	ELGIN
State	:	IL
Zip	:	60123-1782
Country	:	US
Telephone Number	:	847-695-3680
Fax Number	:	224-856-2829

Provider Business Practice Location Address
First Line	:	1140 N MCLEAN BLVD STE I
Second Line	:
City	:	ELGIN
State	:	IL
Zip	:	60123-1782
Country	:	US
Telephone Number	:	847-695-3680
Fax Number	:	224-856-2829

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

Provider Enumeration Date	:	10/24/2012
Last Update Date	:	10/24/2012

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