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Individual

AMY BETH HERTLE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
L.I.C.S.W., L.P.

Contact information

Practice address
3570 LEXINGTON AVE N, SUITE 100, SHOREVIEW, MN 55126-8049
(651) 481-0664
(651) 481-3907
Mailing address
2095 SPRUCE PL, WHITE BEAR LAKE, MN 55110-4731
(651) 890-6031

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
14904
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
968115900
MN
01
HP57337
HEALTH PARTNERS LEGACY ID
MN
Enumeration date
12/14/2006
Last updated
09/08/2019
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