Provider Demographics
NPI:1205443520
Name:WOGOMON, AMBER LYNN (LMSW, LMAC)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNN
Last Name:WOGOMON
Suffix:
Gender:F
Credentials:LMSW, LMAC
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:LYNN
Other - Last Name:MECZWYOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1329 18TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66935-2209
Mailing Address - Country:US
Mailing Address - Phone:785-527-8271
Mailing Address - Fax:785-527-8317
Practice Address - Street 1:209 W 6TH ST
Practice Address - Street 2:
Practice Address - City:CONCORDIA
Practice Address - State:KS
Practice Address - Zip Code:66901-2816
Practice Address - Country:US
Practice Address - Phone:785-560-3101
Practice Address - Fax:785-527-8317
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS00894101YA0400X
KS117721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)