| Amy Hultman Lcsw Pllc | |
|
6723 Weaver Rd Ste 107 Rockford IL 61114-8021 | |
| (815) 621-1930 | |
| Not Available |
| Full Name | Amy Hultman Lcsw Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 6723 Weaver Rd, Rockford, Illinois |
| Authorized Official Name and Position | Amy Hultman (OWNER) |
| Authorized Official Contact | 8156211930 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Amy Hultman Lcsw Pllc 6723 Weaver Rd Ste 107 Rockford IL 61114-8021 Ph: (815) 621-1930 | Amy Hultman Lcsw Pllc 6723 Weaver Rd Ste 107 Rockford IL 61114-8021 Ph: (815) 621-1930 |
| NPI Number | 1255987897 |
|---|---|
| Provider Enumeration Date | 08/09/2019 |
| Last Update Date | 05/01/2023 |
| Certification Date | 05/01/2023 |
| Medicare PECOS PAC ID | 3274965876 |
|---|---|
| Medicare Enrollment ID | O20191120002217 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255987897 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Amy Hultman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548816184 PECOS PAC ID: 4183056781 Enrollment ID: I20191126000938 |
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