Provider Demographics
NPI:1285687483
Name:WILLETTE, AMY CLAIRE (RN, MS, CADC, LCSW)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:CLAIRE
Last Name:WILLETTE
Suffix:
Gender:F
Credentials:RN, MS, CADC, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 ROSE ST
Mailing Address - Street 2:
Mailing Address - City:BLACK RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54615-9201
Mailing Address - Country:US
Mailing Address - Phone:715-284-4058
Mailing Address - Fax:
Practice Address - Street 1:517 COURT ST
Practice Address - Street 2:ROOM 503
Practice Address - City:NEILLSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54456-1971
Practice Address - Country:US
Practice Address - Phone:715-743-5204
Practice Address - Fax:715-743-5209
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12563101YA0400X
WI6640-1231041C0700X
WI81985-030163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health