Individual
AMANDA J FALKERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LPC, SAC
Contact information
Practice address
402 S BLACK RIVER ST STE 125, SPARTA, WI 54656-2043
(608) 501-1189
(888) 928-1124
Mailing address
802 TERRY CT, SPARTA, WI 54656-8806
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
16419-131
WI
101YA0400X
Addiction (Substance Use Disorder) Counselor
17434-130
WI
101YP2500X
Professional Counselor
Primary
6606-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100065211
—
WI
01
—
13979430
CAQH
—
01
—
1750980306
AGENCY NPI NUMBER
—
Enumeration date
03/09/2017
Last updated
10/23/2020
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