MEDICARE: AMY STUMP LPC

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	101YP2500X	Professional Counselor	178019656	IL

General Provider Information

NPI Number	:	1821864885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY STUMP LPC

Provider Business Mailing Address
First Line	:	1444 W BERWYN AVE APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2197
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1444 W BERWYN AVE APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2197
Country	:	US
Telephone Number	:	872-228-5067
Fax Number	:

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

Provider Enumeration Date	:	11/30/2023
Last Update Date	:	11/30/2023

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Directions to “ AMY STUMP LPC” Practice Location

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