Healthcare Provider Details

I. General information

NPI: 1407000490
Provider Name (Legal Business Name): JODI LYNN AMDAHL ADT/RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JODI LYNN HAGER ADT/RDH

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 W PARK ROAD
REDWOOD FALLS MN
56283
US

IV. Provider business mailing address

210 4TH STREET, PO BOX 272
BALATON MN
56115
US

V. Phone/Fax

Practice location:
  • Phone: 507-637-3581
  • Fax: 507-627-8894
Mailing address:
  • Phone: 507-276-1115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH7202
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code125K00000X
TaxonomyAdvanced Practice Dental Therapist
License NumberDT5
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: