Basic Information
| Provider Information | |||||||||
| NPI: | 1215119367 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDERLY-DOTSON | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | JO | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | L.A.D.C., L.G.S.W | ||||||||
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| Mailing Information | |||||||||
| Address1: | 403 4TH ST NW | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | BEMIDJI | ||||||||
| State: | MN | ||||||||
| PostalCode: | 566013142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2184445155 | ||||||||
| FaxNumber: | 2183333291 | ||||||||
| Practice Location | |||||||||
| Address1: | NYSTROM ASSOCIATES LIMITED | ||||||||
| Address2: | 112 1ST STREET WEST | ||||||||
| City: | BEMIDJI | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2188888032 | ||||||||
| FaxNumber: | 2188888033 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2007 | ||||||||
| LastUpdateDate: | 03/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 302225 | MN | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 18704 | MN | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.