Individual
AMANDA BETH MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
E7475 RAWHIDE RD, NEW LONDON, WI 54961-9025
(877) 300-9101
Mailing address
E7475 RAWHIDE RD, NEW LONDON, WI 54961-9025
(877) 300-9101
(920) 531-2686
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3551-226
WI
Other
Enumeration date
12/26/2018
Last updated
12/26/2018
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