Healthcare Provider Details

I. General information

NPI: 1265056592
Provider Name (Legal Business Name): AMSF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 WASHINGTON ST
EVANSTON IL
60202-1632
US

IV. Provider business mailing address

1708 WASHINGTON ST
EVANSTON IL
60202-1632
US

V. Phone/Fax

Practice location:
  • Phone: 815-236-0274
  • Fax:
Mailing address:
  • Phone: 815-236-0274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MEGHAN FINN
Title or Position: OWNER
Credential: LCSW
Phone: 815-236-0274