Provider Demographics
NPI:1083727432
Name:SCANLON, AMANDA (LCPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:SCANLON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 CHESTNUT STREET
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3171
Mailing Address - Country:US
Mailing Address - Phone:630-321-1073
Mailing Address - Fax:630-214-0476
Practice Address - Street 1:522 CHESTNUT ST
Practice Address - Street 2:SUITE 2D
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3171
Practice Address - Country:US
Practice Address - Phone:630-321-1073
Practice Address - Fax:630-214-0476
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004402101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0081646702OtherBCBS
IL0032241345OtherBCBS