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NPI Code Detail

MEDICARE: MS. AMANDA MARIE MODELSKI LPC

MEDICARE: MS. AMANDA MARIE MODELSKI LPC
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
1101Y00000XCounselor178.019417IL

General Provider Information

NPI Number : 1790566107
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. AMANDA MARIE MODELSKI LPC
Provider Business Mailing Address
First Line : 202 WICKER DR
Second Line :
City : DEER PARK
State : IL
Zip : 60010-3723
Country : US
Telephone Number : 847-997-2484
Fax Number :
Provider Business Practice Location Address
First Line : 1137 MCHENRY RD
Second Line :
City : BUFFALO GROVE
State : IL
Zip : 60089-1377
Country : US
Telephone Number : 847-807-8777
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2023
Last Update Date : 10/12/2023

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