Healthcare Provider Details

I. General information

NPI: 1649107343
Provider Name (Legal Business Name): AMANDA ANN VELASQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5831 W 63RD ST APT 2B
CHICAGO IL
60638-5434
US

IV. Provider business mailing address

5831 W 63RD ST APT 2B
CHICAGO IL
60638-5434
US

V. Phone/Fax

Practice location:
  • Phone: 480-313-6777
  • Fax: 855-810-1930
Mailing address:
  • Phone: 480-313-6777
  • Fax: 855-810-1930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number222Q00000X
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: