Individual
AMY B ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
2045
WI
1041C0700X
Clinical Social Worker
149-005163
IL
1041C0700X
Clinical Social Worker
Primary
969-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39638800
—
WI
Enumeration date
07/06/2006
Last updated
11/25/2008
Update your record
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