Provider Demographics
NPI:1518758051
Name:WYNKOOP, AMY LOUISE (MS, LCPC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LOUISE
Last Name:WYNKOOP
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LOUISE
Other - Last Name:WALEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:834 N SEMINARY ST STE 405
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-0500
Mailing Address - Country:US
Mailing Address - Phone:309-343-5114
Mailing Address - Fax:309-717-0124
Practice Address - Street 1:834 N SEMINARY ST STE 405
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-0500
Practice Address - Country:US
Practice Address - Phone:309-343-5114
Practice Address - Fax:309-717-0124
Is Sole Proprietor?:No
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180017040101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health