Healthcare Provider Details

I. General information

NPI: 1164355533
Provider Name (Legal Business Name): AMY MCCALLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 WASHINGTON ST
MONTICELLO MN
55362-8812
US

IV. Provider business mailing address

9780 HAUG AVE NE
MONTICELLO MN
55362-2954
US

V. Phone/Fax

Practice location:
  • Phone: 763-272-2943
  • Fax:
Mailing address:
  • Phone: 763-234-2627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number09120809
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: