| Doctor Name: | AMY M HIGGINBOTHAM |
| NPI Number: | 1104125020 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS |
| License Number: | |
| Business Practice Address: | 571 County Road A Green Lake, WI - 549418630 |
| Business Phone Number: | 9202944070 |
| Business Fax Number: | 9202944139 |
| Mailing Address: | Po Box 588, GREEN LAKE |
| State: | WI |
| Postal Code: | 549410588 |
| Phone Number: | 9202944070 |
| Fax Number: | 9202944139 |
| NPI Enumeration Date: | 03/17/2011 |
| NPI Last Update Date: | 03/17/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |