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General NPI Number Information
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NPI Number | 1871101543
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Entity Type | Individual
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Provider Name | AMY WILKS SAUSAMAN
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Gender | Female
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Dates
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Enumeration Date | 07/20/2020
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Last Update Date | 05/31/2021
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Provider Practice Location Address
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Address Line | 201 W BROADWAY STE F
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City | COLUMBIA
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State | MO
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Zip | 65203-3842
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Country | US
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Telephone | 573-214-0436
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Fax | 573-442-0606
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Provider Business Mailing Address
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Address Line | 3 BRADLEY RD
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City | MORRISTOWN
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State | NJ
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Zip | 07960-6954
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Country | US
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Telephone | 865-405-1538
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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