1215119367 NPI number — MRS. AMY JO ANDERLY-DOTSON L.A.D.C., L.G.S.W

Table of content: MRS. AMY JO ANDERLY-DOTSON L.A.D.C., L.G.S.W (NPI 1215119367)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215119367 NPI number — MRS. AMY JO ANDERLY-DOTSON L.A.D.C., L.G.S.W

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERLY-DOTSON
Provider First Name:
AMY
Provider Middle Name:
JO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.A.D.C., L.G.S.W
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215119367
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
403 4TH ST NW
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
BEMIDJI
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56601-3142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-444-5155
Provider Business Mailing Address Fax Number:
218-333-3291

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NYSTROM ASSOCIATES LIMITED
Provider Second Line Business Practice Location Address:
112 1ST STREET WEST
Provider Business Practice Location Address City Name:
BEMIDJI
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-888-8032
Provider Business Practice Location Address Fax Number:
218-888-8033
Provider Enumeration Date:
11/30/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  302225 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 18704 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)