Healthcare Provider Details

I. General information

NPI: 1518758051
Provider Name (Legal Business Name): AMY LOUISE WYNKOOP LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY LOUISE WALEN

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N 9TH ST
BISMARCK ND
58501-4530
US

IV. Provider business mailing address

400 E 3RD ST
DULUTH MN
55805-1951
US

V. Phone/Fax

Practice location:
  • Phone: 218-786-8364
  • Fax:
Mailing address:
  • Phone: 218-786-8364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180017040
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1443
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: