| Essentia Health Duluth-amberwing Clinic | |
|
615 Pecan Ave Duluth MN 55811 | |
| (218) 355-2100 | |
| (218) 355-2105 |
| Full Name | Essentia Health Duluth-amberwing Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 615 Pecan Ave, Duluth, Minnesota |
| Authorized Official Name and Position | Kevin Boren (CFO) |
| Authorized Official Contact | 2187861009 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Essentia Health Duluth-amberwing Clinic 615 Pecan Ave Duluth MN 55811 Ph: (218) 355-2100 | Essentia Health Duluth-amberwing Clinic 615 Pecan Ave Duluth MN 55811 Ph: (218) 355-2100 |
| NPI Number | 1235488438 |
|---|---|
| Provider Enumeration Date | 09/04/2012 |
| Last Update Date | 02/27/2024 |
| Certification Date | 02/27/2024 |
| Medicare PECOS PAC ID | 5890604011 |
|---|---|
| Medicare Enrollment ID | O20180719001604 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235488438 | NPI | - | NPPES |
| 1033153895 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
| Provider Name | Jessica L Schilling |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1720121486 PECOS PAC ID: 6002912854 Enrollment ID: I20070510000586 |
| Provider Name | Julianne Marie Davis |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1659322915 PECOS PAC ID: 6709897929 Enrollment ID: I20080130000632 |
| Provider Name | Michaela A Merrill Mayfield |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1750573044 PECOS PAC ID: 5597814780 Enrollment ID: I20090518000593 |
| Provider Name | Steven John Sutherland |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1508981333 PECOS PAC ID: 9638215494 Enrollment ID: I20091007000789 |
| Provider Name | Mary Geidner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780882944 PECOS PAC ID: 7113064106 Enrollment ID: I20091023000262 |
| Provider Name | Peder Herbert Svingen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629001656 PECOS PAC ID: 9335276104 Enrollment ID: I20100427000730 |
| Provider Name | Laura Belanger Hoffarth |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427206887 PECOS PAC ID: 1254512247 Enrollment ID: I20110223001268 |
| Provider Name | Rebecca Hoversten-mellem |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992860860 PECOS PAC ID: 7012193485 Enrollment ID: I20110519000276 |
| Provider Name | Elena Brett Metcalf |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1508093337 PECOS PAC ID: 5698911691 Enrollment ID: I20130417000683 |
| Provider Name | Barbara Boehm |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1902052103 PECOS PAC ID: 4486891413 Enrollment ID: I20130513000165 |
| Provider Name | Matthew P Webb |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1891957890 PECOS PAC ID: 6204064215 Enrollment ID: I20140122000082 |
| Provider Name | Mark P Ham |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1306878400 PECOS PAC ID: 0143537829 Enrollment ID: I20150911002137 |
| Provider Name | Lisa M Vanbaalen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679636799 PECOS PAC ID: 9830490465 Enrollment ID: I20151223001453 |
| Provider Name | E. Nightingale |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1508946088 PECOS PAC ID: 7113202599 Enrollment ID: I20181102000296 |
| Provider Name | Maren E Barootian |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801030366 PECOS PAC ID: 2163766114 Enrollment ID: I20181203002414 |
| Provider Name | Ashley Dammer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750805347 PECOS PAC ID: 1052654712 Enrollment ID: I20190521000157 |
| Provider Name | Sigurd M Haller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629494174 PECOS PAC ID: 4880926351 Enrollment ID: I20191101002352 |
| Provider Name | Eileen R Huggins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366079816 PECOS PAC ID: 3577992320 Enrollment ID: I20200331001213 |
| Provider Name | Alyssa L Dye |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780201657 PECOS PAC ID: 5092131128 Enrollment ID: I20200819001806 |
| Provider Name | Kristen Jean Lane |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1497208706 PECOS PAC ID: 0749695419 Enrollment ID: I20210211001169 |
| Provider Name | Carleton Stephen Saxton |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1205289329 PECOS PAC ID: 5092100347 Enrollment ID: I20220323001016 |
| Provider Name | Molly Kathryn Kolquist-kucza |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1649943366 PECOS PAC ID: 9830566504 Enrollment ID: I20221109001758 |
| Provider Name | Taylor Ann Erola |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457076028 PECOS PAC ID: 5496124430 Enrollment ID: I20221213002621 |
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