Provider Demographics
NPI:1881085959
Name:ISUNZA, AMANDA (MSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ISUNZA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-7100
Mailing Address - Country:US
Mailing Address - Phone:608-365-1244
Mailing Address - Fax:608-365-4097
Practice Address - Street 1:416 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511
Practice Address - Country:US
Practice Address - Phone:608-365-1244
Practice Address - Fax:608-365-4097
Is Sole Proprietor?:No
Enumeration Date:2015-02-11
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI129624-121101YM0800X
WI9009-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health