Provider Demographics
NPI:1760295125
Name:GAVIGLIO, AMY (MS, CGC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:GAVIGLIO
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5737 STANDISH AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-2715
Mailing Address - Country:US
Mailing Address - Phone:763-370-9641
Mailing Address - Fax:
Practice Address - Street 1:5737 STANDISH AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2715
Practice Address - Country:US
Practice Address - Phone:763-370-9641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1141170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS