Amy Jacqueline Gulzow, LMT

Primary specialty

DoulaTaxonomy code 374J00000X

License

106415 Issued in OR

Practice address

709 S Main St
Joseph, OR 97846-8513

Phone

(541) 398-0007

NPI assigned

Mar 19, 2008

Reactivated

Feb 1, 2023

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 1, 2023.

{
    "created_epoch": "1205884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675209600000",
    "number": "1922279751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 703",
            "city": "JOSEPH",
            "state": "OR",
            "postal_code": "978460703",
            "telephone_number": "541-398-0007",
            "fax_number": "541-960-3904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 S MAIN ST",
            "city": "JOSEPH",
            "state": "OR",
            "postal_code": "978468513",
            "telephone_number": "541-398-0007"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2442 SE 101st Ave",
            "address_2": "Suite 206",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972163060",
            "country_code": "US",
            "telephone_number": "503-254-7713",
            "fax_number": "503-595-0509",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GULZOW",
        "first_name": "AMY",
        "middle_name": "JACQUELINE",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-03-19",
        "last_updated": "2023-02-01",
        "certification_date": "2023-02-01",
        "deactivation_date": "2022-10-18",
        "reactivation_date": "2023-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "247200000X",
            "taxonomy_group": "",
            "desc": "Technician, Other",
            "state": "OR",
            "license": "12700",
            "primary": false
        },
        {
            "code": "374J00000X",
            "taxonomy_group": "",
            "desc": "Doula",
            "state": "OR",
            "license": "106415",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Joseph, OR
• Doula in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.