Provider Demographics
NPI:1619246824
Name:EJKA, AMANDA M (PSYD)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:M
Last Name:EJKA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 SOUTH 75TH AVENUE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463
Mailing Address - Country:US
Mailing Address - Phone:708-671-8440
Mailing Address - Fax:708-671-8446
Practice Address - Street 1:11800 SOUTH 75TH AVENUE
Practice Address - Street 2:SUITE 300
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463
Practice Address - Country:US
Practice Address - Phone:708-671-8440
Practice Address - Fax:708-671-8446
Is Sole Proprietor?:No
Enumeration Date:2011-12-16
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
IL071.009010103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst