Healthcare Provider Details

I. General information

NPI: 1619340437
Provider Name (Legal Business Name): ACCESS MUSIC THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2015
Last Update Date: 11/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N CENTRAL AVE
DULUTH MN
55807-2402
US

IV. Provider business mailing address

2645 MIDWAY RD
DULUTH MN
55810-2112
US

V. Phone/Fax

Practice location:
  • Phone: 218-349-1792
  • Fax:
Mailing address:
  • Phone: 218-349-1792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name: JODY ANN ST GEORGE TUCKER
Title or Position: CEO/MUSIC THERAPIST
Credential: MA, MT-BC, NMT
Phone: 218-349-1792