Individual
AMANDA J O'CONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
W62N248 WASHINGTON AVE, CEDARBURG, WI 53012-2768
(262) 375-1116
Mailing address
W62N248 WASHINGTON AVE, CEDARBURG, WI 53012-2768
(262) 375-1116
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
O2540109351106
DRIVERS LICENSE
WI
Enumeration date
09/23/2022
Last updated
09/23/2022
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