Individual
AMY SPRAGUE CHAMPEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LMFT
Contact information
Practice address
102 10TH ST, RACINE, WI 53403-1513
(262) 635-9355
Mailing address
102 10TH ST, RACINE, WI 53403-1513
(262) 635-9355
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
166.000914
IL
101YP2500X
Professional Counselor
552-124
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
800011628016
BLUE CROSS BLUE SHIELD
WI
Enumeration date
05/20/2006
Last updated
07/24/2013
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