Provider Demographics
NPI:1659651776
Name:COLUMBUS, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:COLUMBUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 ANN ST
Mailing Address - Street 2:
Mailing Address - City:CLARENDON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60514-1408
Mailing Address - Country:US
Mailing Address - Phone:708-243-1069
Mailing Address - Fax:
Practice Address - Street 1:1048 OGDEN AVE STE 130
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-2896
Practice Address - Country:US
Practice Address - Phone:630-810-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-20
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist