Provider Demographics
NPI:1548022700
Name:WHITENACK, AMY (MS IN CLIN COUNSELI)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:WHITENACK
Suffix:
Gender:F
Credentials:MS IN CLIN COUNSELI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 W TERRA COTTA AVE STE E
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-3407
Mailing Address - Country:US
Mailing Address - Phone:815-707-4806
Mailing Address - Fax:815-977-8715
Practice Address - Street 1:1005 ALEXANDER CT STE E
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013-1891
Practice Address - Country:US
Practice Address - Phone:815-707-4806
Practice Address - Fax:815-977-8715
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health