Individual
AMANDA MARIE ANHALT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, CSAC
Contact information
Practice address
2600 KILEY WAY, PLYMOUTH, WI 53073-5020
(920) 459-1494
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
16200-132
WI
1041C0700X
Clinical Social Worker
Primary
8860-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100075198
—
WI
01
—
16200-132
CLINICAL SUBSTANCE ABUSE COUNSELOR
WI
01
—
8860-123
LICENSED CLINICAL SOCIAL WORKER
WI
Enumeration date
01/23/2018
Last updated
01/19/2026
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