| Amanda Ives Llc | |
|
1021 Sherman Ave Evanston IL 60202-1322 | |
| (312) 402-2460 | |
| (224) 714-0972 |
| Full Name | Amanda Ives Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1021 Sherman Ave, Evanston, Illinois |
| Authorized Official Name and Position | Amanda Ives (OWNER) |
| Authorized Official Contact | 3124022460 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Amanda Ives Llc 1021 Sherman Ave Evanston IL 60202-1322 Ph: (312) 402-2460 | Amanda Ives Llc 1021 Sherman Ave Evanston IL 60202-1322 Ph: (312) 402-2460 |
| NPI Number | 1144942418 |
|---|---|
| Provider Enumeration Date | 09/14/2022 |
| Last Update Date | 07/03/2024 |
| Certification Date | 07/03/2024 |
| Medicare PECOS PAC ID | 8325416720 |
|---|---|
| Medicare Enrollment ID | O20221116000179 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144942418 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Amanda Ives |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689249005 PECOS PAC ID: 0244618619 Enrollment ID: I20220526001194 |
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