MEDICARE: AMY JO SPINNER 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	19115	MN

General Provider Information

NPI Number	:	1851148555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY JO SPINNER MSW, LICSW

Provider Business Mailing Address
First Line	:	400 S 2ND ST STE 125
Second Line	:
City	:	PRINCETON
State	:	MN
Zip	:	55371-1878
Country	:	US
Telephone Number	:	612-787-2212
Fax Number	:	212-504-1176

Provider Business Practice Location Address
First Line	:	400 S 2ND ST STE 125
Second Line	:
City	:	PRINCETON
State	:	MN
Zip	:	55371-1878
Country	:	US
Telephone Number	:	612-787-2212
Fax Number	:	612-504-1176

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

Provider Enumeration Date	:	05/01/2024
Last Update Date	:	05/01/2024

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