Provider Demographics
NPI:1730822172
Name:ROTHLISBERGER, AMBER-LEIGH K
Entity type:Individual
Prefix:
First Name:AMBER-LEIGH
Middle Name:K
Last Name:ROTHLISBERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2653 TWIN PONDS PATH
Mailing Address - Street 2:
Mailing Address - City:MAYER
Mailing Address - State:MN
Mailing Address - Zip Code:55360-7700
Mailing Address - Country:US
Mailing Address - Phone:320-212-5696
Mailing Address - Fax:
Practice Address - Street 1:8401 WAYZATA BLVD STE 150
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55426-1377
Practice Address - Country:US
Practice Address - Phone:763-544-1006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3276101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional