| Amanda Lewis, Msw, Lcsw, Llc | |
| 
					1161 Fortune Blvd Suite 400 Shiloh IL 62269-7385  | |
| (618) 334-5571 | |
| Not Available | 
| Full Name | Amanda Lewis, Msw, Lcsw, Llc | 
|---|---|
| Speciality | Community/Behavioral Health | 
| Location | 1161 Fortune Blvd, Shiloh, Illinois | 
| Authorized Official Name and Position | Amanda Rose Lewis (MANAGING MEMBER) | 
| Authorized Official Contact | 6183345571 | 
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. | 
| Mailing Address | Practice Location Address | 
|---|---|
| Amanda Lewis, Msw, Lcsw, Llc 1161 Fortune Blvd Suite 400 Shiloh IL 62269-7385 Ph: (618) 334-5571  | Amanda Lewis, Msw, Lcsw, Llc 1161 Fortune Blvd Suite 400 Shiloh IL 62269-7385 Ph: (618) 334-5571  | 
| NPI Number | 1598110124 | 
|---|---|
| Provider Enumeration Date | 05/02/2016 | 
| Last Update Date | 05/02/2016 | 
| Medicare PECOS PAC ID | 9133411986 | 
|---|---|
| Medicare Enrollment ID | O20160714001602 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1598110124 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 149.018245 (Illinois) | Primary | 
| Provider Name | Amanda R Lewis | 
|---|---|
| Provider Type | Practitioner - Clinical Social Worker | 
| Provider Identifiers | NPI Number: 1518360171 PECOS PAC ID: 8123318847 Enrollment ID: I20160608000397  | 
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