Healthcare Provider Details

I. General information

NPI: 1912907932
Provider Name (Legal Business Name): AMY HEIMAN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 DIVISION DR STE J
SUGAR GROVE IL
60554-9800
US

IV. Provider business mailing address

330 DIVISION DR STE J
SUGAR GROVE IL
60554-9800
US

V. Phone/Fax

Practice location:
  • Phone: 630-708-0317
  • Fax: 630-277-8362
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180-001844
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: