Healthcare Provider Details

I. General information

NPI: 1477921237
Provider Name (Legal Business Name): AMANDA ORI PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2015
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 N RACINE AVE
CHICAGO IL
60614-7006
US

IV. Provider business mailing address

2000 N RACINE AVE STE 2184
CHICAGO IL
60614-7007
US

V. Phone/Fax

Practice location:
  • Phone: 773-340-0796
  • Fax:
Mailing address:
  • Phone: 773-340-0796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.009744
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: