Healthcare Provider Details

I. General information

NPI: 1497953293
Provider Name (Legal Business Name): AMY AMADA ADAMS BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 WOODLAWN RD
STERLING IL
61081-4151
US

IV. Provider business mailing address

21697 MATHEW RD
STERLING IL
61081-9125
US

V. Phone/Fax

Practice location:
  • Phone: 815-625-0013
  • Fax:
Mailing address:
  • Phone: 815-718-5874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: