MEDICARE: AMBER MARIE DUEY LSW

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
1	101Y00000X	Counselor	3842	ND
2	171M00000X	Case Manager/Care Coordinator	3842	ND
3	104100000X	Social Worker	3842	ND

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720151913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER MARIE DUEY LSW

Provider Business Mailing Address
First Line	:	524 4TH AVE NE
Second Line	:	UNIT 19
City	:	DEVILS LAKE
State	:	ND
Zip	:	58301-2490
Country	:	US
Telephone Number	:	701-662-7050
Fax Number	:	701-662-3360

Provider Business Practice Location Address
First Line	:	524 4TH AVE NE
Second Line	:	UNIT 19
City	:	DEVILS LAKE
State	:	ND
Zip	:	58301-2490
Country	:	US
Telephone Number	:	701-662-7050
Fax Number	:	701-662-3360

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	04/24/2015

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