Amanda Lynn Etlicher
Individual provider Active NPI Professional Counselor · Ripon, WI
NPI 1972846194 · NPPES record last updated Aug 22, 2023
Key facts
- NPI
- 1972846194
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 5860-125 (WI)
- Practice address
- 14 Arcade Glen Rd
Ripon, WI 54971-2100 - Phone
- (920) 539-0225
- NPI assigned
- Apr 5, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5860-125 | WI | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Catalpa Health | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 5860-125 | WI | Yes |
Addresses
Primary practice location
14 Arcade Glen Rd
Ripon, WI 54971-2100
Mailing address
14 Arcade Glen Rd
Ripon, WI 54971-2100
Other providers in Ripon, WI
- Melissa Anne Edinger
- Stephan W. Eiler
- Elite Senior Living - Fountain View, LLC
- Patricia Jane Ellis
- Empower Mental Health Counseling & Consulting, S.C.
- Michael Falahat
- Julie E Felix
- Alicia Burnam Felker
- Kelsey Fenske
- Kelly Jo Field
All providers in Ripon, WI · Professional Counselor in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.