Basic Information
| Provider Information | |||||||||
| NPI: | 1669592002 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEST | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 DEAN ST | ||||||||
| Address2: | |||||||||
| City: | WOODSTOCK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600983220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478024058 | ||||||||
| FaxNumber: | 8153445072 | ||||||||
| Practice Location | |||||||||
| Address1: | 6601 W. NORTH AVE. | ||||||||
| Address2: | |||||||||
| City: | OAK PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038017585 | ||||||||
| FaxNumber: | 3034325071 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2007 | ||||||||
| LastUpdateDate: | 10/19/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 992847 | CO | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 149.018602 | IL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.