Provider Demographics
NPI:1457008625
Name:ALF, AMANDA KAY (LPC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:KAY
Last Name:ALF
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:KAY
Other - Last Name:GEHRMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1025 W GLEN OAKS LN STE 109
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3372
Mailing Address - Country:US
Mailing Address - Phone:262-834-9014
Mailing Address - Fax:262-236-9805
Practice Address - Street 1:1025 W GLEN OAKS LN STE 109
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3372
Practice Address - Country:US
Practice Address - Phone:608-712-1661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7544-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional