Provider Demographics
NPI:1912292145
Name:WEAST, AMY BETH (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BETH
Last Name:WEAST
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W344S10517 COUNTY RD E
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-9552
Mailing Address - Country:US
Mailing Address - Phone:262-745-7297
Mailing Address - Fax:
Practice Address - Street 1:W247S10395 CENTER DR
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-9166
Practice Address - Country:US
Practice Address - Phone:262-971-9100
Practice Address - Fax:262-662-5688
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1931-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical