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General NPI Number Information
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NPI Number | 1467824987
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Entity Type | Individual
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Provider Name | AMANDA SNEED
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Gender | Female
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Dates
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Enumeration Date | 10/23/2015
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Last Update Date | 11/28/2016
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Provider Practice Location Address
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Address Line | 1257 E WALNUT ST STE 1
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City | CARBONDALE
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State | IL
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Zip | 62901-5003
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Country | US
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Telephone | 773-965-6548
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 458
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City | MULKEYTOWN
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State | IL
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Zip | 62865-0458
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Country | US
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Telephone | 773-965-6548
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149018143
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License Number State | IL
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