Provider Demographics
NPI:1235560590
Name:WOLOK, AMY BETH (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:BETH
Last Name:WOLOK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:BETH
Other - Last Name:GIVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:950 LEE ST
Mailing Address - Street 2:212
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-6532
Mailing Address - Country:US
Mailing Address - Phone:847-486-4140
Mailing Address - Fax:847-486-4145
Practice Address - Street 1:950 LEE ST
Practice Address - Street 2:212
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-6532
Practice Address - Country:US
Practice Address - Phone:847-486-4140
Practice Address - Fax:847-486-4145
Is Sole Proprietor?:No
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008721103G00000X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent