Provider Demographics
NPI:1134457674
Name:ROSS, AMBER LETAYE (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:LETAYE
Last Name:ROSS
Suffix:
Gender:
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:LETAYE
Other - Last Name:CULPEPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4240 PARK GLEN RD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-5427
Mailing Address - Country:US
Mailing Address - Phone:612-925-6033
Mailing Address - Fax:612-925-8496
Practice Address - Street 1:6160 SUMMIT DR N STE 450
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2121
Practice Address - Country:US
Practice Address - Phone:763-503-8560
Practice Address - Fax:763-503-8563
Is Sole Proprietor?:No
Enumeration Date:2009-11-20
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN179701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical