Provider Demographics
NPI:1497115448
Name:COLLINS, AMELIA (SAC-IT)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:SAC-IT
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:
Other - Last Name:ECKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LADC
Mailing Address - Street 1:335 E MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:BARRON
Mailing Address - State:WI
Mailing Address - Zip Code:54812-1479
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:335 E MONROE AVE
Practice Address - Street 2:
Practice Address - City:BARRON
Practice Address - State:WI
Practice Address - Zip Code:54812-1479
Practice Address - Country:US
Practice Address - Phone:715-537-6159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304374101YA0400X
WI18996-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1497115448Medicaid