| Doctor Name: | AMY WACKER |
| NPI Number: | 1013076819 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | LPC 845 |
| Business Practice Address: | 25955 W 327th St Paola, KS - 660714920 |
| Business Phone Number: | 9135579096 |
| Business Fax Number: | 9132949247 |
| Mailing Address: | Po Box 677, OTTAWA |
| State: | KS |
| Postal Code: | 660670677 |
| Phone Number: | 9135579096 |
| Fax Number: | 9132949247 |
| NPI Enumeration Date: | 12/07/2006 |
| NPI Last Update Date: | 02/11/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | LPC 845 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KS |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |