Healthcare Provider Details

I. General information

NPI: 1144904186
Provider Name (Legal Business Name): AMANDA S PRIVETT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W CERMAK RD STE 3D
CHICAGO IL
60616-2268
US

IV. Provider business mailing address

600 W CERMAK RD STE 3D
CHICAGO IL
60616-2268
US

V. Phone/Fax

Practice location:
  • Phone: 312-427-6000
  • Fax: 312-427-6004
Mailing address:
  • Phone: 312-427-6000
  • Fax: 312-427-6004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.025596
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: