Provider Demographics
NPI:1033433396
Name:EBERT, AMBER GERBER
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:GERBER
Last Name:EBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 N 2ND ST STE C
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:WI
Mailing Address - Zip Code:54822-7736
Mailing Address - Country:US
Mailing Address - Phone:715-931-0317
Mailing Address - Fax:
Practice Address - Street 1:904 N 2ND ST STE C
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:WI
Practice Address - Zip Code:54822-7736
Practice Address - Country:US
Practice Address - Phone:715-931-0317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-16
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2862-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1033433396Medicaid
WI201950707Medicare PIN