Provider Demographics
NPI:1639885411
Name:ELMER, AMY L (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:ELMER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:WALLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:NORTHWEST COUNSELING & GUIDANCE CLINIC
Mailing Address - Street 2:PO BOX 309
Mailing Address - City:SIREN
Mailing Address - State:WI
Mailing Address - Zip Code:54872-0309
Mailing Address - Country:US
Mailing Address - Phone:715-349-7069
Mailing Address - Fax:
Practice Address - Street 1:1119 W KENNEDY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:KIMBERLY
Practice Address - State:WI
Practice Address - Zip Code:54136-2213
Practice Address - Country:US
Practice Address - Phone:920-364-9668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10070-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical