Provider Demographics
NPI:1992813646
Name:VANWAY, AMY LEA
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LEA
Last Name:VANWAY
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 1:799 S MCLEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-6704
Mailing Address - Country:US
Mailing Address - Phone:847-742-3264
Mailing Address - Fax:847-742-9436
Practice Address - Street 1:799 S MCLEAN BLVD
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-6704
Practice Address - Country:US
Practice Address - Phone:847-742-3264
Practice Address - Fax:847-742-9436
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist