Provider Demographics
NPI:1720616063
Name:GILLE, AMBER LYNN (DT)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNN
Last Name:GILLE
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13262 FOXGLOVE LN
Mailing Address - Street 2:
Mailing Address - City:WINNEBAGO
Mailing Address - State:IL
Mailing Address - Zip Code:61088-9012
Mailing Address - Country:US
Mailing Address - Phone:815-218-2562
Mailing Address - Fax:
Practice Address - Street 1:13262 FOXGLOVE LN
Practice Address - Street 2:
Practice Address - City:WINNEBAGO
Practice Address - State:IL
Practice Address - Zip Code:61088-9012
Practice Address - Country:US
Practice Address - Phone:815-218-2562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator