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General NPI Number Information
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NPI Number | 1083811558
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Entity Type | Individual
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Provider Name | AMANDA GUROCK MS, PLMHP, PMSW
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Gender | Female
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Dates
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Enumeration Date | 06/28/2007
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 9000 W WISCONSIN AVE STE 165
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City | MILWAUKEE
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State | WI
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Zip | 53226-4874
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Country | US
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Telephone | 414-337-3400
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Fax | 414-337-3409
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Provider Business Mailing Address
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Address Line | 9000 W WISCONSIN AVE STE 165
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City | MILWAUKEE
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State | WI
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Zip | 53226-4874
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Country | US
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Telephone | 414-337-3400
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Fax | 414-337-3409
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 7680
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 085242
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 11807-123
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License Number State | WI
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