Healthcare Provider Details

I. General information

NPI: 1255396909
Provider Name (Legal Business Name): NANCY A AMOS-SCHULTE LICENSED CLINICAL SO
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3716 W BRIGHTON
PEORIA IL
61615-2938
US

IV. Provider business mailing address

310 W KNOLL CREST DR
PEORIA IL
61614-7218
US

V. Phone/Fax

Practice location:
  • Phone: 309-692-7755
  • Fax: 309-692-2262
Mailing address:
  • Phone: 309-677-3614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: