Provider Demographics
NPI:1164200804
Name:WATKINS, AMANDA (MASTERS, SAC-IT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:WATKINS
Suffix:
Gender:F
Credentials:MASTERS, SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-5705
Mailing Address - Country:US
Mailing Address - Phone:262-565-5265
Mailing Address - Fax:
Practice Address - Street 1:1331 CAPITOL DR
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-5705
Practice Address - Country:US
Practice Address - Phone:262-565-5265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)