Amy Sue McKenzie, MSW LCSW SAC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

1239-123 Issued in WI

Practice address

1205 North Ave
Cleveland, WI 53015-1413

Phone

(920) 693-5600

Fax

(920) 693-5604

NPI assigned

Sep 6, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Amy Sue Kampmann Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204156800000",
    "number": "1013010024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 NORTH AVE",
            "city": "CLEVELAND",
            "state": "WI",
            "postal_code": "530151413",
            "telephone_number": "920-693-5600",
            "fax_number": "920-693-5604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 NORTH AVE",
            "city": "CLEVELAND",
            "state": "WI",
            "postal_code": "530151413",
            "telephone_number": "920-693-5600",
            "fax_number": "920-693-5604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKENZIE",
        "first_name": "AMY",
        "middle_name": "SUE",
        "name_prefix": "Mrs.",
        "credential": "MSW LCSW SAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-06",
        "last_updated": "2008-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "13279",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "1239-123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42194800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMY",
            "last_name": "KAMPMANN",
            "middle_name": "SUE",
            "credential": "MSW LCSW SAC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Clinical Social Worker in Cleveland, WI
• Providers in Cleveland, WI by specialty
• Clinical Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.