John H Amendt Jr., M.S.W.
Individual provider Active NPI Clinical Social Worker · Glen Ellyn, IL
NPI 1801005665 · NPPES record last updated Feb 6, 2012
Key facts
- NPI
- 1801005665
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 149.001914 (IL)
- Practice address
- 346 Taft Ave
Suite 030
Glen Ellyn, IL 60137-6296 - Phone
- (630) 690-3170
- NPI assigned
- May 21, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 27, 2023 through Apr 27, 2027
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149.001914 | IL | MD | Clinical Social Worker |
| 166.000240 | IL | MD | Marriage & Family Therapist |
| 104956 | TX | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Marriage Clinic | Clinical | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149.001914 | IL | Yes |
| Marriage & Family Therapist | 106H00000X | 166.000240 | IL |
Addresses
Primary practice location
346 Taft Ave
Suite 030
Glen Ellyn, IL 60137-6296
Mailing address
1937 Brentwood LN E
Wheaton, IL 60189-8543
Phone (630) 690-3170
Other providers in Glen Ellyn, IL
- Always Great Smiles Dot Com PC
- Amani Optometry LLC
- Amara Physical Therapy
- Carla Amato-Martz
- Cynthia R Ambler
- American Drug Stores LLC
- Hafsa Amjed
- Penelope A Andersen
- Edwin Anderson
- Jasmine Anish
All providers in Glen Ellyn, IL · Clinical Social Worker in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 6, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.