Provider Demographics
NPI:1659629897
Name:PICCOLO, AMY R (BA)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:R
Last Name:PICCOLO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:R
Other - Last Name:AHMETI-PICCOLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:300 FEMRITE DR
Mailing Address - Street 2:DANE COUNTY CARE CENTER
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-3716
Mailing Address - Country:US
Mailing Address - Phone:608-222-7311
Mailing Address - Fax:608-663-1440
Practice Address - Street 1:300 FEMRITE DR
Practice Address - Street 2:DANE COUNTY CARE CENTER
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-3716
Practice Address - Country:US
Practice Address - Phone:608-222-7311
Practice Address - Fax:608-663-1440
Is Sole Proprietor?:No
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health