Healthcare Provider Details

I. General information

NPI: 1841562311
Provider Name (Legal Business Name): AMANDA NELKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2012
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 MUNICIPAL DR STE D
ARNOLD MO
63010-1043
US

IV. Provider business mailing address

5301 AMBROSE XING
IMPERIAL MO
63052-2090
US

V. Phone/Fax

Practice location:
  • Phone: 573-803-1246
  • Fax: 573-803-1405
Mailing address:
  • Phone: 314-614-3489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: