Provider Demographics
NPI:1598508319
Name:WESTERLUND, AMANDA LEE (IT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:WESTERLUND
Suffix:
Gender:
Credentials:IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1476 KENWOOD DR STE 102
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-1134
Mailing Address - Country:US
Mailing Address - Phone:630-965-7148
Mailing Address - Fax:
Practice Address - Street 1:15300 WATERTOWN PLANK RD STE 106
Practice Address - Street 2:
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2348
Practice Address - Country:US
Practice Address - Phone:414-807-8934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1092-228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist