Provider Demographics
NPI:1215261870
Name:GILLMAN, AMANDA NICHOLE
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:NICHOLE
Last Name:GILLMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 S CLINTON ST APT 114
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3811
Mailing Address - Country:US
Mailing Address - Phone:314-304-3553
Mailing Address - Fax:
Practice Address - Street 1:2425 W PRATT BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-4665
Practice Address - Country:US
Practice Address - Phone:773-338-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor