Provider Demographics
NPI:1558939355
Name:DALTON, AMBER J (MA, LCPC)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:J
Last Name:DALTON
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:SCHULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4136 DEYO AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60513-1806
Mailing Address - Country:US
Mailing Address - Phone:414-839-6567
Mailing Address - Fax:
Practice Address - Street 1:4136 DEYO AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:IL
Practice Address - Zip Code:60513-1806
Practice Address - Country:US
Practice Address - Phone:414-839-6567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.014860101YP2500X
IL180.013709101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional