Provider Demographics
NPI:1912023409
Name:DREW, AMY SUE (BA MHP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:SUE
Last Name:DREW
Suffix:
Gender:F
Credentials:BA MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:61031-9484
Mailing Address - Country:US
Mailing Address - Phone:815-973-5501
Mailing Address - Fax:
Practice Address - Street 1:325 IL ROUTE 2
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-9118
Practice Address - Country:US
Practice Address - Phone:815-284-6611
Practice Address - Fax:815-284-2834
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health