Provider Demographics
NPI:1437534203
Name:SUAREZ, AMANDA J
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
Last Name:SUAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:J
Other - Last Name:MICHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, CSAC
Mailing Address - Street 1:PO BOX 1649
Mailing Address - Street 2:3530 CTY RD F
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53547-1649
Mailing Address - Country:US
Mailing Address - Phone:608-757-5185
Mailing Address - Fax:608-757-5011
Practice Address - Street 1:113 S FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-3812
Practice Address - Country:US
Practice Address - Phone:608-757-5850
Practice Address - Fax:608-757-5545
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-22
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16011101YA0400X
WI86531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100046527Medicaid