| NPI | 1144393497 |
|---|---|
| Former Name | AMY LYNN MEDERNACH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149011842) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 149011842) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2019-05-06 |