Healthcare Provider Details

I. General information

NPI: 1427297183
Provider Name (Legal Business Name): AMY MARIE FIFIELD LPC SASA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2009
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 FREEDOM RD STE A
LITTLE CHUTE WI
54140-3200
US

IV. Provider business mailing address

1800 FREEDOM RD STE A
LITTLE CHUTE WI
54140-3200
US

V. Phone/Fax

Practice location:
  • Phone: 920-460-9009
  • Fax:
Mailing address:
  • Phone: 920-460-9009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15529-130
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number265-226
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4299-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: