Healthcare Provider Details

I. General information

NPI: 1386326973
Provider Name (Legal Business Name): AMANDA ODONOGHUE THOMPSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N MICHIGAN AVE
CHICAGO IL
60601-7511
US

IV. Provider business mailing address

155 N MICHIGAN AVE
CHICAGO IL
60601-7511
US

V. Phone/Fax

Practice location:
  • Phone: 312-819-7381
  • Fax:
Mailing address:
  • Phone: 312-819-7381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.021816
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: