Healthcare Provider Details

I. General information

NPI: 1558819219
Provider Name (Legal Business Name): RACHEL AMODU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOLISTIC BEHAVIORAL AND TMS THERAPY 75 EXECUTIVE DR
AURORA IL
60504
US

IV. Provider business mailing address

250 PARKWAY DR
LINCOLNSHIRE IL
60069-4322
US

V. Phone/Fax

Practice location:
  • Phone: 773-386-0509
  • Fax: 866-314-6133
Mailing address:
  • Phone: 773-386-0509
  • Fax: 866-314-6133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209.025734
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: