Healthcare Provider Details

I. General information

NPI: 1063331866
Provider Name (Legal Business Name): AMANDA MARISSA DEANGELO MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14722 S NAPERVILLE RD
PLAINFIELD IL
60544-3302
US

IV. Provider business mailing address

2248 COUNTRY CLUB DR
WOODRIDGE IL
60517-3029
US

V. Phone/Fax

Practice location:
  • Phone: 815-683-8700
  • Fax:
Mailing address:
  • Phone: 708-937-3934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: