Provider Demographics
NPI:1922424829
Name:OPATZ, AMY (CLC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:OPATZ
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 MCKINLEY PL S
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4007
Mailing Address - Country:US
Mailing Address - Phone:320-267-3408
Mailing Address - Fax:
Practice Address - Street 1:736 MCKINLEY PL S
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4007
Practice Address - Country:US
Practice Address - Phone:320-267-3408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-16
Last Update Date:2014-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAALPP-21157174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN