Individual
AMANDA KAY LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
113 S FRANKLIN ST, JANESVILLE, WI 53548-3812
(608) 743-2417
(608) 743-2406
Mailing address
113 S FRANKLIN ST, JANESVILLE, WI 53548-3812
(608) 743-2417
(608) 743-2406
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
10097
IA
101YA0400X
Addiction (Substance Use Disorder) Counselor
15750
WI
106H00000X
Marriage & Family Therapist
000347
IA
106H00000X
Marriage & Family Therapist
166000869
IL
106H00000X
Marriage & Family Therapist
Primary
903
WI
Other
Enumeration date
08/22/2007
Last updated
12/18/2014
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