Provider Demographics
NPI:1013209279
Name:KOGLIN, AMY CATHERINE (LMFT, BCBA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:CATHERINE
Last Name:KOGLIN
Suffix:
Gender:F
Credentials:LMFT, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 RIVER RESERVE DR
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-2911
Mailing Address - Country:US
Mailing Address - Phone:262-893-8401
Mailing Address - Fax:
Practice Address - Street 1:1020 KABEL AVE
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-3918
Practice Address - Country:US
Practice Address - Phone:715-361-2805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-06
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI956-124106H00000X
WI264-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist