Healthcare Provider Details

I. General information

NPI: 1285941088
Provider Name (Legal Business Name): AMANDA SUSAN GRISWOLD LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA SUSAN PENNING MSW

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E SCHOOL ST
OWATONNA MN
55060-3024
US

IV. Provider business mailing address

333 E SCHOOL ST
OWATONNA MN
55060-3024
US

V. Phone/Fax

Practice location:
  • Phone: 507-444-8115
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: