Healthcare Provider Details

I. General information

NPI: 1457282584
Provider Name (Legal Business Name): AMANDA LANDON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16255 HARTMAN RD
DAVIS IL
61019-9201
US

IV. Provider business mailing address

496 CORKHILL CT
DAVIS IL
61019-9520
US

V. Phone/Fax

Practice location:
  • Phone: 815-526-0901
  • Fax:
Mailing address:
  • Phone: 815-978-5070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178021663
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: