Amanda Radtke, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

3948-226 Issued in WI

Practice address

1716 Lawrence Dr Ste 107
De Pere, WI 54115-9108

Phone

(920) 570-6339

Fax

(920) 243-1792

NPI assigned

Jun 6, 2019

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1559779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648080000000",
    "number": "1841859600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3416 N ASSOCIATION DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549141479",
            "telephone_number": "920-364-9078",
            "fax_number": "920-243-1792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1716 LAWRENCE DR STE 107",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541159108",
            "telephone_number": "920-570-6339",
            "fax_number": "920-243-1792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADTKE",
        "first_name": "AMANDA",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-06",
        "last_updated": "2022-03-24",
        "certification_date": "2022-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "7889-125",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WI",
            "license": "3948-226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amandaradtke@evolvehealing.org",
            "affiliation": "N",
            "endpointDescription": "work email address",
            "address_1": "3416 N Association Dr",
            "city": "Appleton",
            "state": "WI",
            "country_code": "US",
            "postal_code": "549141479",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jessica Provost
• Pyrimad Psychiatric Services and Health Care Management Solutions
• Pyrimad Psychiatric Services and Health Care Management Solutions
• D'Andre Quick
• Courtney M Quinn-Scott, PT, DPT
• Jena Rahmlow
• Anne B. Rakow-Weist, A.T.R.-BC
• Russell Lyle John Reimer Jr., LMT
• Thomas E Reinardy, MD
• Stephanie Marie Reiter, APSW

• Mental Health Counselor in De Pere, WI
• Providers in De Pere, WI by specialty
• Mental Health Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2022; 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.