Basic Information
| Provider Information | |||||||||
| NPI: | 1801063029 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TESMAN | ||||||||
| FirstName: | AMBER | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | RSA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1132 BEL AIRE DR | ||||||||
| Address2: | |||||||||
| City: | RANTOUL | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618661617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2178922798 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1801 FOX DR | ||||||||
| Address2: | |||||||||
| City: | CHAMPAIGN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618207236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173988080 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2008 | ||||||||
| LastUpdateDate: | 05/15/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TR0400X | T25501487607 | IL | Y | Behavioral Health & Social Service Providers | Psychologist | Rehabilitation |
No ID Information.