Individual
AMY REZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
430 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 929-2300
Mailing address
430 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 929-2300
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
16361-132
WI
101YA0400X
Addiction (Substance Use Disorder) Counselor
17238
WI
Other
Enumeration date
05/09/2015
Last updated
12/12/2022
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