Healthcare Provider Details

I. General information

NPI: 1043825722
Provider Name (Legal Business Name): AMARI CARNISE COLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14840 SHEPARD DR
DOLTON IL
60419-2467
US

IV. Provider business mailing address

7808 S LAFLIN ST
CHICAGO IL
60620-4149
US

V. Phone/Fax

Practice location:
  • Phone: 773-449-0859
  • Fax:
Mailing address:
  • Phone: 708-629-5724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: