Provider Demographics
NPI:1447317383
Name:POLLNOW, AMANDA R (AT-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:R
Last Name:POLLNOW
Suffix:
Gender:F
Credentials:AT-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:R
Other - Last Name:BERGMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AT-C
Mailing Address - Street 1:2111 MIDLANDS CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3125
Mailing Address - Country:US
Mailing Address - Phone:815-758-0000
Mailing Address - Fax:815-756-7130
Practice Address - Street 1:2111 MIDLANDS CT
Practice Address - Street 2:SUITE 100
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3125
Practice Address - Country:US
Practice Address - Phone:815-758-0000
Practice Address - Fax:815-756-7130
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0022212255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer