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Individual

AMY B ANDERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MSW

Contact information

Practice address
4109 67TH ST, KENOSHA, WI 53142-3836
(262) 652-9830
(262) 652-2931
Mailing address
4109 67TH ST, KENOSHA, WI 53142-3836
(262) 652-9830
(262) 652-2931

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
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