Provider Demographics
NPI:1619340437
Name:ACCESS MUSIC THERAPY, LLC
Entity Type:Organization
Organization Name:ACCESS MUSIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MUSIC THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ST GEORGE TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MT-BC, NMT
Authorized Official - Phone:218-349-1792
Mailing Address - Street 1:2645 MIDWAY RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55810-2112
Mailing Address - Country:US
Mailing Address - Phone:218-349-1792
Mailing Address - Fax:
Practice Address - Street 1:215 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55807-2402
Practice Address - Country:US
Practice Address - Phone:218-349-1792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty