Healthcare Provider Details

I. General information

NPI: 1861313504
Provider Name (Legal Business Name): AMANDA DELINCK
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4331 LINCOLN HWY
MATTESON IL
60443-2404
US

IV. Provider business mailing address

4331 LINCOLN HWY
MATTESON IL
60443-2404
US

V. Phone/Fax

Practice location:
  • Phone: 708-748-1951
  • Fax: 708-882-0548
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: