Provider Demographics
NPI:1124187588
Name:AMSTUTZ, DONNA RUTH (PHD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:RUTH
Last Name:AMSTUTZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 W ROOSEVELT RD
Mailing Address - Street 2:SUITE D2
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187
Mailing Address - Country:US
Mailing Address - Phone:630-510-9225
Mailing Address - Fax:630-510-0669
Practice Address - Street 1:610 W ROOSEVELT RD
Practice Address - Street 2:SUITE D2
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187
Practice Address - Country:US
Practice Address - Phone:630-510-9225
Practice Address - Fax:630-510-0669
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL943630Medicare ID - Type Unspecified