Provider Demographics
NPI:1134097645
Name:GROLL, AMANDA J (LPC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
Last Name:GROLL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:J
Other - Last Name:FARRAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 959
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53082-0959
Mailing Address - Country:US
Mailing Address - Phone:920-783-6633
Mailing Address - Fax:920-783-6392
Practice Address - Street 1:1721 SAEMANN AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-2342
Practice Address - Country:US
Practice Address - Phone:920-783-6633
Practice Address - Fax:920-783-6392
Is Sole Proprietor?:No
Enumeration Date:2025-10-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8628-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional