Provider Demographics
NPI: | 1457599987 |
---|---|
Name: | SAVAGE, AMY LYNN LUER (PSYD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | AMY |
Middle Name: | LYNN LUER |
Last Name: | SAVAGE |
Suffix: | |
Gender: | F |
Credentials: | PSYD |
Other - Prefix: | DR |
Other - First Name: | AMY |
Other - Middle Name: | LYNN LUER |
Other - Last Name: | SAVAGE |
Other - Suffix: | |
Other - Last Name Type: | Professional Name |
Other - Credentials: | PSYD |
Mailing Address - Street 1: | 4610 N KEDVALE AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | CHICAGO |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60630-4305 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 773-427-0259 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4610 N KEDVALE AVE |
Practice Address - Street 2: | |
Practice Address - City: | CHICAGO |
Practice Address - State: | IL |
Practice Address - Zip Code: | 60630-4305 |
Practice Address - Country: | US |
Practice Address - Phone: | 773-540-7571 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2009-01-21 |
Last Update Date: | 2013-11-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IL | CADC | 101YA0400X |
IL | 071.007819 | 103T00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IL | 071007819 | Other | LICENSE |