MEDICARE: AMY JEAN DAUM LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	6401225026	MI
2	101YM0800X	Mental Health Counselor	8720-125	WI

General Provider Information

NPI Number	:	1922720671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY JEAN DAUM LPC

Provider Business Mailing Address
First Line	:	S6202 COUNTY ROAD PF
Second Line	:
City	:	NORTH FREEDOM
State	:	WI
Zip	:	53951-9643
Country	:	US
Telephone Number	:	608-291-4066
Fax Number	:

Provider Business Practice Location Address
First Line	:	S6202 COUNTY ROAD PF
Second Line	:
City	:	NORTH FREEDOM
State	:	WI
Zip	:	53951-9643
Country	:	US
Telephone Number	:	608-291-4066
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2022
Last Update Date	:	02/26/2025

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