Healthcare Provider Details

I. General information

NPI: 1861708539
Provider Name (Legal Business Name): AMANDA BORDE COLLIER MSW, BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2010
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 MINNESOTA ST STE 1500
SAINT PAUL MN
55101-2269
US

IV. Provider business mailing address

16412 DRAFT HORSE BLVD
LAKEVILLE MN
55044-4603
US

V. Phone/Fax

Practice location:
  • Phone: 646-941-7645
  • Fax: 929-596-7897
Mailing address:
  • Phone: 612-839-8809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21559
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: