Healthcare Provider Details

I. General information

NPI: 1134664311
Provider Name (Legal Business Name): AMP GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2016
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 W SUPERIOR ST STE 620
DULUTH MN
55802-1723
US

IV. Provider business mailing address

324 W SUPERIOR ST STE 620
DULUTH MN
55802-1723
US

V. Phone/Fax

Practice location:
  • Phone: 218-606-1797
  • Fax: 651-952-0039
Mailing address:
  • Phone: 218-606-1797
  • Fax: 651-925-0039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ANGELIC KOSKI
Title or Position: PRESIDENT
Credential:
Phone: 218-591-2648