Provider Demographics
NPI:1215363858
Name:HEMENWAY, AMY P (M ED)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:P
Last Name:HEMENWAY
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9273 COACH STOP RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-3429
Mailing Address - Country:US
Mailing Address - Phone:618-910-1937
Mailing Address - Fax:
Practice Address - Street 1:9273 COACH STOP RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-3429
Practice Address - Country:US
Practice Address - Phone:618-910-1937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-14
Last Update Date:2015-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.001167101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional