Healthcare Provider Details

I. General information

NPI: 1982508453
Provider Name (Legal Business Name): AMANDA MATHY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 S GREELEY ST STE 356
MILWAUKEE WI
53207-2024
US

IV. Provider business mailing address

2625 S GREELEY ST STE 356
MILWAUKEE WI
53207-2024
US

V. Phone/Fax

Practice location:
  • Phone: 414-644-0006
  • Fax: 262-316-3900
Mailing address:
  • Phone: 414-644-0006
  • Fax: 262-316-3900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7779-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: