Provider Demographics
NPI:1508219668
Name:GANYO, AMELIA MARIE (MA)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:MARIE
Last Name:GANYO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:MARIE
Other - Last Name:SCHMITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 603
Mailing Address - Street 2:
Mailing Address - City:CROOKSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56716-0603
Mailing Address - Country:US
Mailing Address - Phone:218-280-2847
Mailing Address - Fax:
Practice Address - Street 1:603 BRUCE ST
Practice Address - Street 2:
Practice Address - City:CROOKSTON
Practice Address - State:MN
Practice Address - Zip Code:56716-2914
Practice Address - Country:US
Practice Address - Phone:218-281-3940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MNCC02321101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health