MEDICARE: AMY E DEAN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149.014119	IL

General Provider Information

NPI Number	:	1336615905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY E DEAN LCSW

Provider Business Mailing Address
First Line	:	2919 CROSSING CT STE 13
Second Line	:
City	:	CHAMPAIGN
State	:	IL
Zip	:	61822-5904
Country	:	US
Telephone Number	:	217-394-5382
Fax Number	:

Provider Business Practice Location Address
First Line	:	2919 CROSSING CT STE 13
Second Line	:
City	:	CHAMPAIGN
State	:	IL
Zip	:	61822-5904
Country	:	US
Telephone Number	:	217-394-5382
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2018
Last Update Date	:	08/09/2020

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Directions to “ AMY E DEAN LCSW” Practice Location

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