Individual
AMY TAAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, SAC
Contact information
Practice address
1476 KENWOOD DR STE 102, MENASHA, WI 54952-1134
(920) 939-8868
Mailing address
1476 KENWOOD DR STE 102, MENASHA, WI 54952-1134
(920) 939-8868
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
3679-226
WI
101YA0400X
Addiction (Substance Use Disorder) Counselor
16225-131
WI
101YM0800X
Mental Health Counselor
Primary
3679-226
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
813042847
—
WI
Enumeration date
09/25/2017
Last updated
04/20/2026
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