Provider Demographics
NPI:1255396909
Name:AMOS-SCHULTE, NANCY A (LICENSED CLINICAL SO)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:A
Last Name:AMOS-SCHULTE
Suffix:
Gender:F
Credentials:LICENSED CLINICAL SO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W KNOLL CREST DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-7218
Mailing Address - Country:US
Mailing Address - Phone:309-677-3614
Mailing Address - Fax:
Practice Address - Street 1:3716 W BRIGHTON
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-2938
Practice Address - Country:US
Practice Address - Phone:309-692-7755
Practice Address - Fax:309-692-2262
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical