Provider Demographics
NPI:1912873837
Name:PARKER, AMY (LICSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W3543 MANN RD
Mailing Address - Street 2:
Mailing Address - City:LOYAL
Mailing Address - State:WI
Mailing Address - Zip Code:54446-8340
Mailing Address - Country:US
Mailing Address - Phone:715-937-1420
Mailing Address - Fax:
Practice Address - Street 1:W3543 MANN RD
Practice Address - Street 2:
Practice Address - City:LOYAL
Practice Address - State:WI
Practice Address - Zip Code:54446-8340
Practice Address - Country:US
Practice Address - Phone:715-937-1420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3636-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical