Healthcare Provider Details

I. General information

NPI: 1811223829
Provider Name (Legal Business Name): AMY LOUISE SPONSLER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 12/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 W PARK ST
URBANA IL
61801
US

IV. Provider business mailing address

411 W GREEN ST APT 2N
URBANA IL
61801-7857
US

V. Phone/Fax

Practice location:
  • Phone: 217-373-2430
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: