Amy Beth Hertle, L.I.C.S.W., L.P.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

14904 Issued in MN

Practice address

3570 Lexington Ave N
Suite 100
Shoreview, MN 55126-8049

Phone

(651) 481-0664

Fax

(651) 481-3907

NPI assigned

Dec 14, 2006

Last updated

Sep 8, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Crosswinds Counseling

  • Clinical Social Worker
  • White Bear Lake, MN
  • NPI 1477876993
  Medicare reassignment NPD Authorized official
• Outreach Counseling & Consulting Services, Inc.

  • Professional Counselor
  • Shoreview, MN
  • NPI 1295890192
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567900800000",
    "number": "1376605808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2095 SPRUCE PL",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551104731",
            "telephone_number": "651-890-6031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3570 LEXINGTON AVE N",
            "address_2": "SUITE 100",
            "city": "SHOREVIEW",
            "state": "MN",
            "postal_code": "551268049",
            "telephone_number": "651-481-0664",
            "fax_number": "651-481-3907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERTLE",
        "first_name": "AMY",
        "middle_name": "BETH",
        "credential": "L.I.C.S.W., L.P.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-14",
        "last_updated": "2019-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "14904",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "968115900",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS LEGACY ID",
            "identifier": "HP57337",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Ruth Hayes I, C.N.M.
• Melanie Haynes, LGSW
• Michael Douglas Head, D.C.
• Michael Henderson, DDS
• Toni Henning, MS, CCC-SLP
• Levi John Hibma
• Annie Elizabeth Hinnenkamp
• Nathan Philip Hinrichs, MD
• Sherri Hinrichs
• Elizabeth Rose Hofbauer, M.D.

• Clinical Social Worker in Shoreview, MN
• Providers in Shoreview, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.