Provider Demographics
NPI:1104116839
Name:GEFFERS, AMY L
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:GEFFERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P,O. BOX 2187
Mailing Address - Street 2:220 WASHINGTON AVE.
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54903
Mailing Address - Country:US
Mailing Address - Phone:920-236-1267
Mailing Address - Fax:
Practice Address - Street 1:220 WASHINGTON AVE.
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54903
Practice Address - Country:US
Practice Address - Phone:920-236-1267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15323-132101YA0400X
WI8880-120104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)