Provider Demographics
NPI:1285415885
Name:PETERKA, AMANDA MARIE (CAPSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:PETERKA
Suffix:
Gender:F
Credentials:CAPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1699 SCHOFIELD AVE STE 119-120
Mailing Address - Street 2:
Mailing Address - City:SCHOFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54476-2338
Mailing Address - Country:US
Mailing Address - Phone:715-907-1880
Mailing Address - Fax:715-907-1888
Practice Address - Street 1:1699 SCHOFIELD AVE STE 119-120
Practice Address - Street 2:
Practice Address - City:SCHOFIELD
Practice Address - State:WI
Practice Address - Zip Code:54476-2338
Practice Address - Country:US
Practice Address - Phone:715-907-1880
Practice Address - Fax:715-907-1888
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI134488-1211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical