Healthcare Provider Details

I. General information

NPI: 1992629398
Provider Name (Legal Business Name): AMY BERNARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 SHERMAN AVE
EVANSTON IL
60201-4361
US

IV. Provider business mailing address

5500 N LAKEWOOD AVE # 2
CHICAGO IL
60640-1313
US

V. Phone/Fax

Practice location:
  • Phone: 184-742-5970
  • Fax:
Mailing address:
  • Phone: 786-261-5582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.022987
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: