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General NPI Number Information
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NPI Number | 1043048853
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Entity Type | Individual
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Provider Name | AMANDA JO REIMER SAC-IT, SWTC
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Gender | Female
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Dates
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Enumeration Date | 07/23/2024
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Last Update Date | 07/23/2024
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Provider Practice Location Address
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Address Line | 505 BROADWAY ST
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City | BARABOO
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State | WI
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Zip | 53913-2183
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Country | US
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Telephone | 608-355-4200
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Fax | 608-355-4299
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Provider Business Mailing Address
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Address Line | 505 BROADWAY ST
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City | BARABOO
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State | WI
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Zip | 53913-2183
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Country | US
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Telephone | 608-355-4200
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Fax | 608-355-4299
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 20618130
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License Number State | WI
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