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General NPI Number Information
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NPI Number | 1295935849
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Entity Type | Organization
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Legal Business Name | AMY WOLD MA, LP, PA
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 07/23/2007
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Provider Practice Location Address
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Address Line | 101 LEXINGTON AVE S
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City | NEW PRAGUE
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State | MN
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Zip | 56071-2423
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Country | US
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Telephone | 952-758-2999
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Fax | 952-758-2999
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Provider Business Mailing Address
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Address Line | 101 LEXINGTON AVE S
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City | NEW PRAGUE
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State | MN
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Zip | 56071-2423
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Country | US
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Telephone | 952-758-2999
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Fax | 952-758-2999
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Authorized Official
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Title or Position | OWNER, SELF
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Name | MS. AMY WOLD
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Credential | MA, LP, PA
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Telephone | 952-758-2999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 3821
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License Number State | MN
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