Provider Demographics
NPI:1386216547
Name:BROOKS, AMY LYNN (LGSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 NEW ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55806-2114
Mailing Address - Country:US
Mailing Address - Phone:218-340-3980
Mailing Address - Fax:
Practice Address - Street 1:2421 LONDON RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812-2222
Practice Address - Country:US
Practice Address - Phone:218-789-2542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN299101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical