Healthcare Provider Details

I. General information

NPI: 1619513645
Provider Name (Legal Business Name): AMANDA E COMER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 W WAVERLY ST
MORRIS IL
60450-1334
US

IV. Provider business mailing address

725 SCHOOL ST STE A
MORRIS IL
60450-1207
US

V. Phone/Fax

Practice location:
  • Phone: 815-941-0441
  • Fax: 815-941-0472
Mailing address:
  • Phone: 815-941-9124
  • Fax: 815-941-4363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.020893
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: