Provider Demographics
NPI:1013010024
Name:MCKENZIE, AMY SUE (MSW LCSW SAC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:SUE
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:MSW LCSW SAC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:SUE
Other - Last Name:KAMPMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW LCSW SAC
Mailing Address - Street 1:1205 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:WI
Mailing Address - Zip Code:53015-1413
Mailing Address - Country:US
Mailing Address - Phone:920-693-5600
Mailing Address - Fax:920-693-5604
Practice Address - Street 1:1205 NORTH AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:WI
Practice Address - Zip Code:53015-1413
Practice Address - Country:US
Practice Address - Phone:920-693-5600
Practice Address - Fax:920-693-5604
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13279101YA0400X
WI1239-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42194800Medicaid