Provider Demographics
NPI:1235504432
Name:STROUD, AMBER (MS, LPC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:STROUD
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 1:624 N 66TH ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-4060
Mailing Address - Country:US
Mailing Address - Phone:414-708-1271
Mailing Address - Fax:
Practice Address - Street 1:119 MILL RD
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:WI
Practice Address - Zip Code:53156-9310
Practice Address - Country:US
Practice Address - Phone:262-370-5527
Practice Address - Fax:262-495-8689
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3885-125101YP2500X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional