Gragg, Amanda L

Gragg, Amanda L is an individual health care provider with primary practice located at 1020 N 12Th St , Milwaukee WI 53233-1308. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Professional, Behavioral Health & Social Service Providers / Mental Health. Behavioral Health & Social Service Providers / Mental Health is her primary health care specialty. Gragg, Amanda L can be contacted via phone (414) 773-4312.

Contact Information

Primary practice address
1020 N 12Th St Milwaukee WI 53233-1308
Phone: (414) 773-4312
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X 4828125 Wisconsin
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 4828 Wisconsin

Profile Details

NPI number 1033455324
LBN Legal business name Gragg, Amanda L
Credentials Licensed Professional Counselor (LPC)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 14th, 2012
Last updated Nov 18th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1033455324 NPPES
Wisconsin MEDICAID 100027409

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