Provider Demographics
NPI:1255987897
Name:AMY HULTMAN LCSW PLLC
Entity type:Organization
Organization Name:AMY HULTMAN LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:HULTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:815-621-1930
Mailing Address - Street 1:6723 WEAVER RD
Mailing Address - Street 2:STE 107
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-8021
Mailing Address - Country:US
Mailing Address - Phone:815-621-1930
Mailing Address - Fax:
Practice Address - Street 1:6723 WEAVER RD
Practice Address - Street 2:STE 107
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-8021
Practice Address - Country:US
Practice Address - Phone:815-621-1930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-09
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty