Provider Demographics
NPI:1669209987
Name:NAWN, AMELIA (LSW)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:NAWN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 N WINNEBAGO AVE APT C
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-5346
Mailing Address - Country:US
Mailing Address - Phone:847-899-4063
Mailing Address - Fax:
Practice Address - Street 1:2135 W ROSCOE ST STE 1N
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-6277
Practice Address - Country:US
Practice Address - Phone:773-542-3128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty