Healthcare Provider Details

I. General information

NPI: 1154721579
Provider Name (Legal Business Name): AMY MEDLIN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1771 BLACKBERRY RD
AURORA IL
60506-9762
US

IV. Provider business mailing address

1771 BLACKBERRY RD
AURORA IL
60506-9762
US

V. Phone/Fax

Practice location:
  • Phone: 630-292-3912
  • Fax: 331-226-0022
Mailing address:
  • Phone: 630-292-3912
  • Fax: 331-226-0022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180010200
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180010200
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: