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General NPI Number Information
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NPI Number | 1053657825
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Entity Type | Organization
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Legal Business Name | AMY ANSON, PH.D., & ASSOCIATES, LLC
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Dates
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Enumeration Date | 12/22/2012
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Last Update Date | 01/03/2013
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Provider Practice Location Address
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Address Line | 3330 OLD GLENVIEW RD SUITE 1
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City | WILMETTE
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State | IL
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Zip | 60091-2963
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Country | US
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Telephone | 847-791-5078
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Fax |
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Provider Business Mailing Address
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Address Line | 9020 TRIPP AVE
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City | SKOKIE
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State | IL
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Zip | 60076-1608
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | DR. AMY ANSON
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Credential | PH.D.
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Telephone | 847-791-5078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071-0005222
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License Number State | IL
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