Healthcare Provider Details

I. General information

NPI: 1003636598
Provider Name (Legal Business Name): AMY THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15701 COUNTY ROAD K STE 3
DARLINGTON WI
53530-9251
US

IV. Provider business mailing address

15701 COUNTY ROAD K STE 3
DARLINGTON WI
53530-9251
US

V. Phone/Fax

Practice location:
  • Phone: 608-776-4800
  • Fax: 833-464-0892
Mailing address:
  • Phone: 608-776-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12375-123
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: