Most Relevant Information
Provider Data
| NPI Number: | 1003388380 |
| Provider Name: | AMANDA BETH MARTIN |
| Entity Type: | Individual |
| Taxonomy Code: | 101YP2500X |
| Specialty: | Counselor |
| License Number: | 3551-226 |
Most Important Dates
| Enumeration Date: | 12/26/2018 |
| Last Updated: | 12/26/2018 |
Provider Practice Location
E7475 RAWHIDE RD
NEW LONDON
WI
549619025
Practice Location Phone/Fax
| Phone: | 8773009101 |
| Fax: |
Provider Mailing Location
E7475 RAWHIDE RD
NEW LONDON
WI
549619025
Provider Mailing Phone/Fax
| Phone: | 8773009101 |
| Fax: | 9205312686 |