Healthcare Provider Details

I. General information

NPI: 1447802756
Provider Name (Legal Business Name): AMY MEYER LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E LEFEVRE RD
STERLING IL
61081-1279
US

IV. Provider business mailing address

20169 PIGEON RD
MORRISON IL
61270-9773
US

V. Phone/Fax

Practice location:
  • Phone: 815-625-0400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180014894
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: