Provider Demographics
NPI:1225418486
Name:LEVANETZ, AMBER RENEE
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:RENEE
Last Name:LEVANETZ
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 1:2337 EFFINGHAM WAY
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-3705
Mailing Address - Country:US
Mailing Address - Phone:608-215-3035
Mailing Address - Fax:
Practice Address - Street 1:2337 EFFINGHAM WAY
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-3705
Practice Address - Country:US
Practice Address - Phone:608-215-3035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3220-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional