Healthcare Provider Details

I. General information

NPI: 1609168509
Provider Name (Legal Business Name): AMANDA ADAMS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA BORDWELL

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 WAUKEGAN RD STE 1198
GLENVIEW IL
60025-2122
US

IV. Provider business mailing address

1509 WAUKEGAN RD STE 1198
GLENVIEW IL
60025-2122
US

V. Phone/Fax

Practice location:
  • Phone: 312-554-5851
  • Fax:
Mailing address:
  • Phone: 312-554-5851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number166001152
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: