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NPI Code Detail

MEDICARE: AMBER NICOLE EGDORF MA, LADC, LPCC

MEDICARE: AMBER NICOLE EGDORF MA, LADC, LPCC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YP2500XProfessional Counselor4285MN

General Provider Information

NPI Number : 1780120378
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMBER NICOLE EGDORF MA, LADC, LPCC
Provider Business Mailing Address
First Line : 245 RUTH ST N STE 101
Second Line :
City : SAINT PAUL
State : MN
Zip : 55119-4409
Country : US
Telephone Number : 651-955-4633
Fax Number :
Provider Business Practice Location Address
First Line : 245 RUTH ST N STE 101
Second Line :
City : SAINT PAUL
State : MN
Zip : 55119-4409
Country : US
Telephone Number : 651-955-4633
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2017
Last Update Date : 02/05/2024

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Directions to “ AMBER NICOLE EGDORF MA, LADC, LPCC” Practice Location

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