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NPI Code Detail

MEDICARE: BRITTNI AMANDA INGVALDSON

MEDICARE: BRITTNI AMANDA INGVALDSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor04654MN
2101YA0400XAddiction (Substance Use Disorder) Counselor304240MN

General Provider Information

NPI Number : 1922772383
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRITTNI AMANDA INGVALDSON
Provider Business Mailing Address
First Line : 5241 LINCOLN DR APT 113
Second Line :
City : EDINA
State : MN
Zip : 55436-2701
Country : US
Telephone Number : 507-363-1672
Fax Number :
Provider Business Practice Location Address
First Line : 17645 JUNIPER PATH STE 105
Second Line :
City : LAKEVILLE
State : MN
Zip : 55044-7491
Country : US
Telephone Number : 952-600-8191
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2021
Last Update Date : 12/06/2024

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Directions to “ BRITTNI AMANDA INGVALDSON ” Practice Location

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