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General NPI Number Information
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NPI Number | 1770023202
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Entity Type | Individual
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Provider Name | AMANDA LEA FORTIER PHD
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Gender | Female
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Dates
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Enumeration Date | 03/02/2017
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Last Update Date | 03/02/2017
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Provider Practice Location Address
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Address Line | 5400 PEARL ST
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City | ROSEMONT
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State | IL
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Zip | 60018-5305
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Country | US
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Telephone | 847-349-7464
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Fax | 847-349-7409
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Provider Business Mailing Address
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Address Line | 5400 PEARL ST
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City | ROSEMONT
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State | IL
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Zip | 60018-5305
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Country | US
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Telephone | 847-349-7464
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Fax | 847-349-7409
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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 | 170100000X
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Taxonomy Name | Ph.D. Medical Genetics
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License Number |
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License Number State |
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