Provider Demographics
NPI:1720435530
Name:GORS, AMBER
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:GORS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7058 ROUTE 72 LOT 14
Mailing Address - Street 2:
Mailing Address - City:STILLMAN VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61084-9621
Mailing Address - Country:US
Mailing Address - Phone:815-601-1119
Mailing Address - Fax:
Practice Address - Street 1:7058 ROUTE 72 LOT 14
Practice Address - Street 2:
Practice Address - City:STILLMAN VALLEY
Practice Address - State:IL
Practice Address - Zip Code:61084-9621
Practice Address - Country:US
Practice Address - Phone:815-601-1119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-22
Last Update Date:2016-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker