Amanda Lucille Soukup

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

096.004076 Issued in IL

Practice address

240 Westridge Blvd
Bartlett, IL 60103-1347

Phone

(630) 433-8990

NPI assigned

Sep 4, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1441324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724976000000",
    "number": "1235507427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 WESTRIDGE BLVD",
            "city": "BARTLETT",
            "state": "IL",
            "postal_code": "601031347",
            "telephone_number": "630-433-8990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 WESTRIDGE BLVD",
            "city": "BARTLETT",
            "state": "IL",
            "postal_code": "601031347",
            "telephone_number": "630-433-8990"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "540 E Constitution Dr Apt 4",
            "address_purpose": "LOCATION",
            "city": "Palatine",
            "state": "IL",
            "postal_code": "600741912",
            "country_code": "US",
            "telephone_number": "630-433-8990",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SOUKUP",
        "first_name": "AMANDA",
        "middle_name": "LUCILLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-04",
        "last_updated": "2024-08-30",
        "certification_date": "2024-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IL",
            "license": "096.004076",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Bartlett, IL
• Providers in Bartlett, IL by specialty
• Athletic Trainer in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.