Provider Demographics
NPI:1417323114
Name:KRUMENACHER, AMY (MS,CSAC, LPC, ICS-IT)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:KRUMENACHER
Suffix:
Gender:F
Credentials:MS,CSAC, LPC, ICS-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W BROADWAY FL 2
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-4833
Mailing Address - Country:US
Mailing Address - Phone:262-547-5567
Mailing Address - Fax:262-547-1608
Practice Address - Street 1:101 W BROADWAY FL 2
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-4833
Practice Address - Country:US
Practice Address - Phone:262-547-5567
Practice Address - Fax:262-547-1608
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2854-226101YM0800X
WI16069-132101YA0400X
WI6539-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)