Provider Demographics
NPI:1609543065
Name:WESNESKI, AMANDA KAY (LCSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAY
Last Name:WESNESKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 KINWEST PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3409
Mailing Address - Country:US
Mailing Address - Phone:214-940-9089
Mailing Address - Fax:469-314-8706
Practice Address - Street 1:1175 KINWEST PKWY STE 100
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3409
Practice Address - Country:US
Practice Address - Phone:214-940-9089
Practice Address - Fax:469-314-8706
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX664771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical