Provider Demographics
NPI:1639579394
Name:POWELSON, AMELIA KILPATRICK (PSYD)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:KILPATRICK
Last Name:POWELSON
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 1:401 S LA SALLE ST STE 800H
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-1057
Mailing Address - Country:US
Mailing Address - Phone:312-588-9672
Mailing Address - Fax:
Practice Address - Street 1:401 S LA SALLE ST STE 800H
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-1057
Practice Address - Country:US
Practice Address - Phone:312-588-9672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health