=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346167822
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMANDA KERUZE MA, LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2026
-----------------------------------------------------
Last Update Date | 07/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5301 CONEY WESTON PL
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53711-1003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-695-4197
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5301 CONEY WESTON PL
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53711-1003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-695-4197
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 12361-125
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------