Provider Demographics
NPI:1982118550
Name:DES FORGE, AMY (MS, LPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:DES FORGE
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 SILVER LAKE RD NW STE 110
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-1789
Mailing Address - Country:US
Mailing Address - Phone:612-628-9566
Mailing Address - Fax:651-628-0411
Practice Address - Street 1:3703 OAKWOOD HILLS PKWY STE 100
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4458
Practice Address - Country:US
Practice Address - Phone:534-444-4562
Practice Address - Fax:534-444-4563
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-18
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6583-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional