Basic Information
| Provider Information | |||||||||
| NPI: | 1255877148 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZALOKAR | ||||||||
| FirstName: | AMANDA | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4211 DANBURY LN | ||||||||
| Address2: | |||||||||
| City: | MOUNT PLEASANT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 534034020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2629140720 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1333 COLLEGE AVE | ||||||||
| Address2: | |||||||||
| City: | RACINE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 534031920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2626874011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2017 | ||||||||
| LastUpdateDate: | 04/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 17909-130 | WI | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 104100000X | 130498-121 | WI | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 9292-123 | WI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.