1811050560 NPI number — MS. AMY GRACE PYRON HUGO MSW, LICSW

Table of content: MS. AMY GRACE PYRON HUGO MSW, LICSW (NPI 1811050560)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811050560 NPI number — MS. AMY GRACE PYRON HUGO MSW, LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PYRON HUGO
Provider First Name:
AMY
Provider Middle Name:
GRACE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HUGO
Provider Other First Name:
AMY
Provider Other Middle Name:
GRACE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LICSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1811050560
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 1ST AVE NW STE 210
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55901-2830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-951-5143
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/17/2006

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: 1041C0700X , with the licence number:  12309 , 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: 12309 , 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)

  • Identifier: 647227300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".