Provider Demographics
NPI:1164521126
Name:JAHNKE, AMY L (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:L
Last Name:JAHNKE
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 321
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-0321
Mailing Address - Country:US
Mailing Address - Phone:920-743-4428
Mailing Address - Fax:
Practice Address - Street 1:50 S MADISON AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-2742
Practice Address - Country:US
Practice Address - Phone:920-743-4428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3774101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor