Provider Demographics
NPI:1083811558
Name:GUROCK, AMANDA (MS, PLMHP, PMSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:GUROCK
Suffix:
Gender:F
Credentials:MS, PLMHP, PMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 W WISCONSIN AVE STE 165
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-337-3400
Mailing Address - Fax:414-337-3409
Practice Address - Street 1:9000 W WISCONSIN AVE STE 165
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-337-3400
Practice Address - Fax:414-337-3409
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7680101YM0800X
NY0852421041C0700X
WI11807-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health