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34 N Main St St Augustine IL 61474-9800 | |
| (309) 351-8584 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 34 N Main St, St Augustine, Illinois |
| Authorized Official Name and Position | Amanda Sheree Powell (OWNER) |
| Authorized Official Contact | 3093330293 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
34 N Main St St Augustine IL 61474-9800 Ph: (309) 351-8584 | 34 N Main St St Augustine IL 61474-9800 Ph: (309) 351-8584 |
| NPI Number | 1922743608 |
|---|---|
| Provider Enumeration Date | 04/28/2022 |
| Last Update Date | 10/15/2024 |
| Certification Date | 10/15/2024 |
| Medicare PECOS PAC ID | 7618356510 |
|---|---|
| Medicare Enrollment ID | O20220623002290 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922743608 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Amanda S Powell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962086744 PECOS PAC ID: 3274932777 Enrollment ID: I20210603002662 |