MEDICARE: MISS AMBER RENEE MCDONALD

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	106S00000X	Behavior Technician
2	101YP2500X	Professional Counselor	178.021696	IL

General Provider Information

NPI Number	:	1982239406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS AMBER RENEE MCDONALD

Provider Business Mailing Address
First Line	:	14723 WABASH AVE
Second Line	:
City	:	DOLTON
State	:	IL
Zip	:	60419-1618
Country	:	US
Telephone Number	:	708-250-9099
Fax Number	:

Provider Business Practice Location Address
First Line	:	14723 WABASH AVE
Second Line	:
City	:	DOLTON
State	:	IL
Zip	:	60419-1618
Country	:	US
Telephone Number	:	708-305-8991
Fax Number	:

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

Provider Enumeration Date	:	03/04/2020
Last Update Date	:	02/05/2026

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