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General NPI Number Information
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NPI Number | 1881161917
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Entity Type | Individual
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Provider Name | AMBER LOCKIE FERGUSON LCSW, CSAC, CS-IT
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Gender | Female
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Dates
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Enumeration Date | 10/26/2018
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Last Update Date | 04/17/2024
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Provider Practice Location Address
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Address Line | 407 S MAIN ST
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City | VIROQUA
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State | WI
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Zip | 54665-2100
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Country | US
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Telephone | 608-637-3195
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Fax |
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Provider Business Mailing Address
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Address Line | 1836 SOUTH AVE
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City | LA CROSSE
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State | WI
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Zip | 54601-5429
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Country | US
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Telephone | 608-782-7300
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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 | 10167-123
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License Number State | WI
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