Healthcare Provider Details

I. General information

NPI: 1154828838
Provider Name (Legal Business Name): AMARA TANWEER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMMAARAH TANWEER

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

657 W FULTON ST UNIT 603
CHICAGO IL
60661-1289
US

IV. Provider business mailing address

657 W FULTON ST UNIT 603
CHICAGO IL
60661-1289
US

V. Phone/Fax

Practice location:
  • Phone: 406-686-6463
  • Fax:
Mailing address:
  • Phone: 406-686-6463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number071023097
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: