Healthcare Provider Details

I. General information

NPI: 1467193987
Provider Name (Legal Business Name): AMBER BUZICK LCSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 S COLUMBIA RD STE A217
GRAND FORKS ND
58201-4054
US

IV. Provider business mailing address

1395 S COLUMBIA RD STE A
GRAND FORKS ND
58201-4054
US

V. Phone/Fax

Practice location:
  • Phone: 701-732-3367
  • Fax:
Mailing address:
  • Phone: 701-732-3367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3978
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number18300
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: