Provider Demographics
NPI:1669554101
Name:AUKES, AMY ROCHELLE (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:ROCHELLE
Last Name:AUKES
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:WHEAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 RIVENDELL DR
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-9188
Mailing Address - Country:US
Mailing Address - Phone:501-316-1255
Mailing Address - Fax:
Practice Address - Street 1:100 RIVENDELL DR
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-9188
Practice Address - Country:US
Practice Address - Phone:501-316-1255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1913-M104100000X
AR2316-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5V049Medicare PIN