Provider Demographics
NPI:1952119224
Name:CUNNINGHAM, AMANDA NICHOLE (BS SAC-IT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:NICHOLE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:BS SAC-IT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:NICHOLE
Other - Last Name:ROWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1224 CHAPIN ST
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-6437
Mailing Address - Country:US
Mailing Address - Phone:608-481-0933
Mailing Address - Fax:
Practice Address - Street 1:203 W SUNNY LN
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-9091
Practice Address - Country:US
Practice Address - Phone:608-741-4515
Practice Address - Fax:608-741-4516
Is Sole Proprietor?:No
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20661-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)