Provider Demographics
NPI:1821466038
Name:KOHEL, AMY MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:KOHEL
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:M
Other - Last Name:PRICKETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:W7327 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166-1143
Mailing Address - Country:US
Mailing Address - Phone:715-524-6854
Mailing Address - Fax:
Practice Address - Street 1:W7327 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-1143
Practice Address - Country:US
Practice Address - Phone:715-524-6854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-03
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
WI122031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker