Provider Demographics
NPI:1972984219
Name:WAZIO, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:WAZIO
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 1:3317 W 95TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2243
Mailing Address - Country:US
Mailing Address - Phone:708-466-7924
Mailing Address - Fax:708-529-3207
Practice Address - Street 1:3317 W 95TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2243
Practice Address - Country:US
Practice Address - Phone:708-466-7924
Practice Address - Fax:708-529-3207
Is Sole Proprietor?:No
Enumeration Date:2015-06-12
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.009220101YP2500X
IL180.012121101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional