Provider Demographics
NPI:1285056366
Name:SCHRUPP, AMY L (CSW-PIP, LAC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:SCHRUPP
Suffix:
Gender:F
Credentials:CSW-PIP, LAC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:CANTRAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2900 DOOLITTLE DR BLDG 6000
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH AFB
Mailing Address - State:SD
Mailing Address - Zip Code:57706-4821
Mailing Address - Country:US
Mailing Address - Phone:605-385-3656
Mailing Address - Fax:605-385-2030
Practice Address - Street 1:2900 DOOLITTLE DR BLDG 6000
Practice Address - Street 2:
Practice Address - City:ELLSWORTH AFB
Practice Address - State:SD
Practice Address - Zip Code:57706-4821
Practice Address - Country:US
Practice Address - Phone:605-385-3656
Practice Address - Fax:605-385-2030
Is Sole Proprietor?:No
Enumeration Date:2014-01-09
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD13031561101YA0400X
SD60761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5200010Medicare UPIN