Provider Demographics
NPI:1851160683
Name:KRUMMICK, AMIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMIE
Middle Name:
Last Name:KRUMMICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 BEDFORD LN
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3004
Mailing Address - Country:US
Mailing Address - Phone:847-477-6234
Mailing Address - Fax:
Practice Address - Street 1:611 ROCKLAND RD STE 204
Practice Address - Street 2:
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-2000
Practice Address - Country:US
Practice Address - Phone:847-477-6234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-22-59617103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst