Healthcare Provider Details

I. General information

NPI: 1932025467
Provider Name (Legal Business Name): AMELIA VAZQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6211 DURAND AVE STE 202
MOUNT PLEASANT WI
53406-4956
US

IV. Provider business mailing address

1129 N JACKSON ST APT 909
MILWAUKEE WI
53202-3286
US

V. Phone/Fax

Practice location:
  • Phone: 262-447-8999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: