Provider Demographics
NPI:1366401408
Name:KERSTEN, AMY E (LCSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:KERSTEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15857 TERRIS LN
Mailing Address - Street 2:
Mailing Address - City:SAINT ROBERT
Mailing Address - State:MO
Mailing Address - Zip Code:65584-7505
Mailing Address - Country:US
Mailing Address - Phone:907-687-2963
Mailing Address - Fax:
Practice Address - Street 1:119 N BENTON ST
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583-2501
Practice Address - Country:US
Practice Address - Phone:573-433-2833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2015-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMH8832Medicaid
AK152651Medicare ID - Type Unspecified
OTH000Medicare UPIN