| Doctor Name: | AMY TANNER |
| NPI Number: | 1134265077 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 149.011144 |
| Business Practice Address: | 61 S Old Rand Rd Lake Zurich, IL - 600473127 |
| Business Phone Number: | 8474384222 |
| Business Fax Number: | 8474380844 |
| Mailing Address: | 5805 W Eddy St, Unit 1d CHICAGO |
| State: | IL |
| Postal Code: | 606344390 |
| Phone Number: | 7734301075 |
| Fax Number: | |
| NPI Enumeration Date: | 01/29/2007 |
| NPI Last Update Date: | 02/13/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 149.011144 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |