Healthcare Provider Details

I. General information

NPI: 1154615193
Provider Name (Legal Business Name): AMY JOHNSON TREMAIN LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3228 6TH AVE NE UNIT B
ROCHESTER MN
55906
US

IV. Provider business mailing address

3228 6TH AVE NE UNIT B
ROCHESTER MN
55906-3809
US

V. Phone/Fax

Practice location:
  • Phone: 507-226-4576
  • Fax: 507-258-5000
Mailing address:
  • Phone: 507-226-4576
  • Fax: 507-258-5000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberLP4160
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: