Provider Demographics
NPI:1003054339
Name:BAUER-GAMBLA, AMBER D (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:D
Last Name:BAUER-GAMBLA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:AMBER
Other - Middle Name:D
Other - Last Name:BAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:25 EAST WASHINGTON STREET
Mailing Address - Street 2:SUITE 1601
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602
Mailing Address - Country:US
Mailing Address - Phone:773-412-0010
Mailing Address - Fax:
Practice Address - Street 1:25 EAST WASHINGTON STREET
Practice Address - Street 2:SUITE 1601
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602
Practice Address - Country:US
Practice Address - Phone:312-720-8008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-23
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007604103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical