Provider Demographics
NPI:1851077150
Name:WEIDER, AMY (MA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:WEIDER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 N BELL AVE APT 2F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-3064
Mailing Address - Country:US
Mailing Address - Phone:920-277-7837
Mailing Address - Fax:
Practice Address - Street 1:155 N MICHIGAN AVE STE 622
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7593
Practice Address - Country:US
Practice Address - Phone:312-912-3978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health