Provider Demographics
NPI:1043611205
Name:DONATH, AMANDA (LPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:DONATH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 SUMMIT AVE STE 714
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-3827
Mailing Address - Country:US
Mailing Address - Phone:262-226-2006
Mailing Address - Fax:262-226-2462
Practice Address - Street 1:712 SUMMIT AVE STE 714
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-3827
Practice Address - Country:US
Practice Address - Phone:262-226-2006
Practice Address - Fax:262-226-2462
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5382-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional