Healthcare Provider Details

I. General information

NPI: 1336224922
Provider Name (Legal Business Name): AMY LYNN HENNING LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 PARK PL STE 200
APPLETON WI
54914-8232
US

IV. Provider business mailing address

1810 APPLETON ROAD
MENASHA WI
54952
US

V. Phone/Fax

Practice location:
  • Phone: 920-212-1456
  • Fax:
Mailing address:
  • Phone: 920-739-4226
  • Fax: 920-739-7639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3520-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: