MEDICARE: MS. AMY GRACE PYRON HUGO MSW, 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
1	1041C0700X	Clinical Social Worker	12309	MN
2	101YM0800X	Mental Health Counselor	12309	MN

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	:	1811050560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMY GRACE PYRON HUGO MSW, LICSW

Provider Business Mailing Address
First Line	:	7492 COUNTY ROAD 15 SW
Second Line	:
City	:	STEWARTVILLE
State	:	MN
Zip	:	55976-8195
Country	:	US
Telephone Number	:	507-951-9942
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 1ST AVE NW STE 210
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55901-2830
Country	:	US
Telephone Number	:	507-951-5143
Fax Number	:

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

Provider Enumeration Date	:	12/17/2006
Last Update Date	:	09/14/2021

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