| NPI | 1972888584 |
|---|---|
| Former Name | AMANDA L SUPP |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2013012287) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180007838) |
| Enumeration Date | 2011-10-14 |
| Last Update Date | 2016-11-30 |