Provider Demographics
NPI:1164629226
Name:METSCHKE, AMY L (LADC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:METSCHKE
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2979 LITTLE SALT RD
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:NE
Mailing Address - Zip Code:68434-7803
Mailing Address - Country:US
Mailing Address - Phone:402-646-2240
Mailing Address - Fax:
Practice Address - Street 1:510 BRADFORD
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:NE
Practice Address - Zip Code:68434-2170
Practice Address - Country:US
Practice Address - Phone:402-643-0535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE714101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)