Healthcare Provider Details

I. General information

NPI: 1841132164
Provider Name (Legal Business Name): AMY CHRISTINE ANDERSON LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 CENTRAL AVE S
MAPLETON MN
56065-7520
US

IV. Provider business mailing address

801 CENTRAL AVE S
MAPLETON MN
56065-7520
US

V. Phone/Fax

Practice location:
  • Phone: 507-524-3918
  • Fax:
Mailing address:
  • Phone: 507-524-3918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number15408
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: