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General NPI Number Information
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NPI Number | 1831344670
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Entity Type | Individual
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Provider Name | AMY C VANCE LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/20/2008
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 11518 N PORT WASHINGTON RD STE 202
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City | MEQUON
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State | WI
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Zip | 53092-3443
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Country | US
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Telephone | 262-999-3495
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Fax |
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Provider Business Mailing Address
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Address Line | 5330 N NAVAJO AVE
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City | GLENDALE
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State | WI
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Zip | 53217-5035
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Country | US
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Telephone | 503-277-3522
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 12156-123
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 15717
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License Number State | OR
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