Provider Demographics
NPI:1770023202
Name:FORTIER, AMANDA LEA (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LEA
Last Name:FORTIER
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:5400 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:ROSEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60018-5305
Mailing Address - Country:US
Mailing Address - Phone:847-349-7464
Mailing Address - Fax:847-349-7409
Practice Address - Street 1:5400 PEARL ST
Practice Address - Street 2:
Practice Address - City:ROSEMONT
Practice Address - State:IL
Practice Address - Zip Code:60018-5305
Practice Address - Country:US
Practice Address - Phone:847-349-7464
Practice Address - Fax:847-349-7409
Is Sole Proprietor?:No
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics