Provider Demographics
NPI:1639301104
Name:LOPEZ, AMY LYNN (MS, LPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4402 S 68TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-3479
Mailing Address - Country:US
Mailing Address - Phone:414-321-4411
Mailing Address - Fax:414-321-0552
Practice Address - Street 1:4402 S 68TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-3479
Practice Address - Country:US
Practice Address - Phone:414-321-4411
Practice Address - Fax:414-321-0552
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4256-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional