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Amy Wacker

Counselor

Behavioral Health & Social Service Providers

25955 W 327th St, Paola, KS 66071-4920

(913) 557-9096

PECOS Enrollment

Based on the most recent information from CMS, provider Amy Wacker does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 11:54 AM.

Profile Details

Provider ID
1013076819
Provider Type
Individual
Full Name
Wacker, Amy
Credential
LPC

Gender
Female
Sole Proprietor
No
Enumeration Date
12/7/2006
Last Updated
2/11/2013

Contact Information

Practice Location

25955 W 327th St, Paola, KS 66071-4920

(913) 557-9096

(913) 294-9247

Mailing Location

PO Box 677, Ottawa, KS 66067-0677

(913) 557-9096

(913) 294-9247

Provider Taxonomies

Code	Description	License
Code 101YM0800X Primary	Description Counselor Behavioral Health & Social Service Providers	License LPC 845 Kansas

Provider Identifiers

ID	Description	Issuer
ID 200431960A	Description Medicaid	Issuer Unlisted Kansas

Amy Wacker

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Lauterbach, Amy Lyn

Purdy, Telisa L

Huffman, Robin L

Main, Sydney

Bindi, Gracie

Johnson, Donna R

Waddle, Elizabeth

Sunflower Centers Of Kansas, Inc

Cordts, Barbara A

Ayres, Reg A