MEDICARE: AMY OPATZ CLC

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	174N00000X	Lactation Consultant (Non-RN)	ALPP-21157	MA

General Provider Information

NPI Number	:	1922424829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY OPATZ CLC

Provider Business Mailing Address
First Line	:	736 MCKINLEY PL S
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56301-4007
Country	:	US
Telephone Number	:	320-267-3408
Fax Number	:

Provider Business Practice Location Address
First Line	:	736 MCKINLEY PL S
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56301-4007
Country	:	US
Telephone Number	:	320-267-3408
Fax Number	:

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

Provider Enumeration Date	:	03/16/2014
Last Update Date	:	03/16/2014

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