Provider Demographics
NPI:1154615193
Name:TREMAIN, AMY JOHNSON (LP)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:JOHNSON
Last Name:TREMAIN
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3228 6TH AVE NE UNIT B
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-3809
Mailing Address - Country:US
Mailing Address - Phone:507-226-4576
Mailing Address - Fax:507-258-5000
Practice Address - Street 1:3228 6TH AVE NE UNIT B
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906
Practice Address - Country:US
Practice Address - Phone:507-226-4576
Practice Address - Fax:507-258-5000
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4160103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN115-4615193OtherOTHER, NPI