Provider Demographics
NPI:1417243023
Name:HARTMAN, AMANDA BROOKE (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:BROOKE
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:BROOKE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LSW
Mailing Address - Street 1:945 W GEORGE ST
Mailing Address - Street 2:STE 206
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5893
Mailing Address - Country:US
Mailing Address - Phone:312-256-5706
Mailing Address - Fax:
Practice Address - Street 1:945 W GEORGE ST
Practice Address - Street 2:STE 206
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5893
Practice Address - Country:US
Practice Address - Phone:312-256-5706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006529A1041C0700X
IL1490170201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200939800AMedicaid