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General NPI Number Information
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NPI Number | 1376605808
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Entity Type | Individual
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Provider Name | AMY BETH HERTLE L.I.C.S.W., L.P.
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Gender | Female
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 09/08/2019
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Provider Practice Location Address
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Address Line | 3570 LEXINGTON AVE N SUITE 100
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City | SHOREVIEW
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State | MN
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Zip | 55126-8049
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Country | US
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Telephone | 651-481-0664
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Fax | 651-481-3907
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Provider Business Mailing Address
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Address Line | 2095 SPRUCE PL
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City | WHITE BEAR LAKE
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State | MN
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Zip | 55110-4731
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Country | US
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Telephone | 651-890-6031
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 14904
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License Number State | MN
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