Provider Demographics
NPI:1841859600
Name:RADTKE, AMANDA (LPC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:RADTKE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3416 N ASSOCIATION DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-1479
Mailing Address - Country:US
Mailing Address - Phone:920-364-9078
Mailing Address - Fax:920-243-1792
Practice Address - Street 1:1716 LAWRENCE DR STE 107
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-9108
Practice Address - Country:US
Practice Address - Phone:920-570-6339
Practice Address - Fax:920-243-1792
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7889-125101YP2500X
WI3948-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional