Healthcare Provider Details

I. General information

NPI: 1750816856
Provider Name (Legal Business Name): AMANDA FELGENHAUER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2017
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15303 S 94TH AVE STE 250
ORLAND PARK IL
60462-3825
US

IV. Provider business mailing address

7774 W 174TH AVE
LOWELL IN
46356-9804
US

V. Phone/Fax

Practice location:
  • Phone: 888-428-7890
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178016870
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB360427
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: