Healthcare Provider Details

I. General information

NPI: 1326515321
Provider Name (Legal Business Name): AMY ANN KUHAGEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2018
Last Update Date: 10/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 S 70TH ST
WEST ALLIS WI
53214-3151
US

IV. Provider business mailing address

3235 S 82ND CT
MILWAUKEE WI
53219-3541
US

V. Phone/Fax

Practice location:
  • Phone: 414-475-2788
  • Fax:
Mailing address:
  • Phone: 414-514-4003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8363
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: