Provider Demographics
NPI:1922393099
Name:HOLLY, AMANDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:HOLLY
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 1:9855 WOODS DR
Mailing Address - Street 2:SUITE G105
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1074
Mailing Address - Country:US
Mailing Address - Phone:847-966-9343
Mailing Address - Fax:847-966-9563
Practice Address - Street 1:9855 WOODS DR
Practice Address - Street 2:SUITE G105
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1074
Practice Address - Country:US
Practice Address - Phone:847-966-9343
Practice Address - Fax:847-966-9563
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-007489103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist