Provider Demographics
NPI:1679044630
Name:KINGSLEY, AMBER MARGARET
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MARGARET
Last Name:KINGSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50306 287TH AVE
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:MN
Mailing Address - Zip Code:55932-5252
Mailing Address - Country:US
Mailing Address - Phone:507-259-7962
Mailing Address - Fax:
Practice Address - Street 1:1725 STATE ST
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-3742
Practice Address - Country:US
Practice Address - Phone:608-785-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer