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General NPI Number Information
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NPI Number | 1679395016
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Entity Type | Individual
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Provider Name | AMANDA JO WEBB SAC-IT
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Gender | Female
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 210 WASHINGTON ST
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City | WAUSAU
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State | WI
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Zip | 54403-5543
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Country | US
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Telephone | 855-540-5806
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Fax |
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Provider Business Mailing Address
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Address Line | 1340 MARIA DR
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City | STEVENS POINT
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State | WI
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Zip | 54481-1141
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Country | US
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Telephone | 715-630-1548
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Fax |
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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 | 20695-130
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License Number State | WI
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