Provider Demographics
NPI:1922720671
Name:DAUM, AMY JEAN (LPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JEAN
Last Name:DAUM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S6202 COUNTY ROAD PF
Mailing Address - Street 2:
Mailing Address - City:NORTH FREEDOM
Mailing Address - State:WI
Mailing Address - Zip Code:53951-9643
Mailing Address - Country:US
Mailing Address - Phone:608-291-4066
Mailing Address - Fax:
Practice Address - Street 1:S6202 COUNTY ROAD PF
Practice Address - Street 2:
Practice Address - City:NORTH FREEDOM
Practice Address - State:WI
Practice Address - Zip Code:53951-9643
Practice Address - Country:US
Practice Address - Phone:608-291-4066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8720-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty