Provider Demographics
NPI:1639820020
Name:AMANULLAH, ASMA (LSW)
Entity Type:Individual
Prefix:
First Name:ASMA
Middle Name:
Last Name:AMANULLAH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23908 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-2122
Mailing Address - Country:US
Mailing Address - Phone:773-934-7381
Mailing Address - Fax:
Practice Address - Street 1:23819 W MILL ST STE 7
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-3460
Practice Address - Country:US
Practice Address - Phone:815-683-8700
Practice Address - Fax:815-384-1061
Is Sole Proprietor?:No
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.105613104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker