Provider Demographics
NPI:1487348702
Name:ROBERTS, AMY MARIE (LPC-IT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1699 SCHOFIELD AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:SCHOFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54476-2332
Mailing Address - Country:US
Mailing Address - Phone:715-907-1880
Mailing Address - Fax:
Practice Address - Street 1:222 CHRISTY ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:WI
Practice Address - Zip Code:54406-9390
Practice Address - Country:US
Practice Address - Phone:715-907-1880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7413-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional