Individual
AMBER MALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SAC-IT
Contact information
Practice address
151 E BADGER RD, MADISON, WI 53713-2708
(608) 250-2512
Mailing address
212 14TH AVE, NEW GLARUS, WI 53574-9703
(608) 219-5347
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
06/08/2017
Last updated
06/08/2017
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