Provider Demographics
NPI:1467207985
Name:STOTLER, AMANDA (CADC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:STOTLER
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 UNION ST
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-2426
Mailing Address - Country:US
Mailing Address - Phone:815-941-6126
Mailing Address - Fax:
Practice Address - Street 1:1320 UNION ST
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-2426
Practice Address - Country:US
Practice Address - Phone:815-941-6126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)