Healthcare Provider Details

I. General information

NPI: 1922720671
Provider Name (Legal Business Name): AMY JEAN DAUM LPC, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

S6202 COUNTY ROAD PF
NORTH FREEDOM WI
53951-9643
US

IV. Provider business mailing address

PO BOX 104
NORTH FREEDOM WI
53951-0104
US

V. Phone/Fax

Practice location:
  • Phone: 608-291-4066
  • Fax:
Mailing address:
  • Phone: 608-432-5627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401225026
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number138842
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2025007601
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8720-125
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2607232
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: