Amanda Kay Lake

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

903 Issued in WI

Practice address

113 S Franklin St
Janesville, WI 53548-3812

Phone

(608) 743-2417

Fax

(608) 743-2406

NPI assigned

Aug 22, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

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": "1187740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418860800000",
    "number": "1992998900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 S FRANKLIN ST",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535483812",
            "telephone_number": "608-743-2417",
            "fax_number": "608-743-2406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 S FRANKLIN ST",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535483812",
            "telephone_number": "608-743-2417",
            "fax_number": "608-743-2406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "AMANDA",
        "middle_name": "KAY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-08-22",
        "last_updated": "2014-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IA",
            "license": "10097",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "15750",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "IA",
            "license": "000347",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "WI",
            "license": "903",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "IL",
            "license": "166000869",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ellen Nancy Kursel, OT
• Jodi Lynn Kurtz, DNP NP-C, WHNP-BC
• Michael Kwon
• Elizabeth Jane Kyburz, PHARMD
• Jennifer L Laatsch, PA-C
• Amin A Lakhdhir, M.D.
• Leah Lammersfeld, PT
• Jacob A. Landvatter, MD
• Marsha M. Landvatter, MD
• Penny L Landvogt, PH D LLC

• All providers in Janesville, WI
• Marriage & Family Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2014; 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.