Healthcare Provider Details

I. General information

NPI: 1982239406
Provider Name (Legal Business Name): MISS AMBER RENEE MCDONALD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2020
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14723 WABASH AVE
DOLTON IL
60419-1618
US

IV. Provider business mailing address

14723 WABASH AVE
DOLTON IL
60419-1618
US

V. Phone/Fax

Practice location:
  • Phone: 708-305-8991
  • Fax:
Mailing address:
  • Phone: 708-250-9099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.021696
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: