Anderson, Amy B

Anderson, Amy B is an individual health care provider with primary practice located at 4109 67Th St , Kenosha WI 53142-3836. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Anderson, Amy B can be contacted via phone (262) 652-9830.

Contact Information

Primary practice address
4109 67Th St Kenosha WI 53142-3836
Phone: (262) 652-9830
Fax: (262) 652-2931
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 2045 Wisconsin
Behavioral Health & Social Service Providers / Clinical 1041C0700X 969-123 Wisconsin
Behavioral Health & Social Service Providers / Clinical 1041C0700X 149-005163 Illinois

Profile Details

NPI number 1295766186
LBN Legal business name Anderson, Amy B
Credentials MSW
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 6th, 2006
Last updated Nov 25th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1295766186 NPPES
Wisconsin MEDICAID 39638800

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