Provider Demographics
NPI:1326489691
Name:ROCK, AMY E (CMC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:ROCK
Suffix:
Gender:F
Credentials:CMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3208 W LAKE ST # 102
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4512
Mailing Address - Country:US
Mailing Address - Phone:510-220-2819
Mailing Address - Fax:
Practice Address - Street 1:3208 W LAKE ST # 102
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-4512
Practice Address - Country:US
Practice Address - Phone:510-220-2819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator