Healthcare Provider Details

I. General information

NPI: 1992588552
Provider Name (Legal Business Name): AMANDA JANE HUNT HUEWE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ELM ST N
FARGO ND
58102-2417
US

IV. Provider business mailing address

4453 18TH ST S
MOORHEAD MN
56560-7189
US

V. Phone/Fax

Practice location:
  • Phone: 701-232-3241
  • Fax:
Mailing address:
  • Phone: 218-368-0741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: