Healthcare Provider Details

I. General information

NPI: 1962293290
Provider Name (Legal Business Name): AMANDA RETZER MSW, LSW, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 05/15/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1952 MCDOWELL RD #305
NAPERVILLE IL
60563
US

IV. Provider business mailing address

160 S RIVER ST UNIT 306
AURORA IL
60506-6075
US

V. Phone/Fax

Practice location:
  • Phone: 630-689-1022
  • Fax:
Mailing address:
  • Phone: 224-595-6419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number38899
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150113864
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: