Provider Demographics
NPI:1871101543
Name:SAUSAMAN, AMY WILKS
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:WILKS
Last Name:SAUSAMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BRADLEY RD
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6954
Mailing Address - Country:US
Mailing Address - Phone:865-405-1538
Mailing Address - Fax:
Practice Address - Street 1:201 W BROADWAY STE F
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-3842
Practice Address - Country:US
Practice Address - Phone:573-214-0436
Practice Address - Fax:573-442-0606
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional