Provider Demographics
NPI:1134457674
Name:ROSS, AMBER LETAYE (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LETAYE
Last Name:ROSS
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SIBLEY ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-1941
Mailing Address - Country:US
Mailing Address - Phone:651-256-1236
Mailing Address - Fax:651-291-7378
Practice Address - Street 1:400 SIBLEY ST
Practice Address - Street 2:SUITE 500
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-1941
Practice Address - Country:US
Practice Address - Phone:651-256-1236
Practice Address - Fax:651-291-7378
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN179701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical