Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 4335 | WI |
NPI | 1003463589 |
---|---|
Provider Name | Amanda Mckeaton |
First Address | Janesville, WI 53548-3863 |
Second Address | Janesville, WI 53548-3863 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2019 |
Last Update Date | 20/08/2019 |