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NPI Code Detail

MEDICARE: MS. AMY L. KEPHART LICSW

MEDICARE: MS. AMY L. KEPHART LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker28099MN

General Provider Information

NPI Number : 1174845119
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. AMY L. KEPHART LICSW
Provider Business Mailing Address
First Line : 5121 UPTON AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55410-2246
Country : US
Telephone Number : 347-746-0522
Fax Number : 651-925-0427
Provider Business Practice Location Address
First Line : 3033 EXCELSIOR BLVD STE 215
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55416-5274
Country : US
Telephone Number : 347-746-0522
Fax Number : 651-925-0427
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/18/2010
Last Update Date : 10/22/2025

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