Provider Demographics
NPI:1518104116
Name:YEHOSHUA, AMY ALICIA (LAC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ALICIA
Last Name:YEHOSHUA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 W EUGENIA ST
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-2139
Mailing Address - Country:US
Mailing Address - Phone:847-571-9949
Mailing Address - Fax:
Practice Address - Street 1:525 TYLER RD STE S
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-3363
Practice Address - Country:US
Practice Address - Phone:331-901-5672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-19
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198000817171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist