Provider Demographics
NPI:1659723591
Name:VALLEM, AMY (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:VALLEM
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 TAZEWELL DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-7149
Mailing Address - Country:US
Mailing Address - Phone:618-799-9737
Mailing Address - Fax:
Practice Address - Street 1:8 EAGLE CTR STE 15
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1947
Practice Address - Country:US
Practice Address - Phone:618-207-3543
Practice Address - Fax:855-813-0212
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-03
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490185501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical