Healthcare Provider Details

I. General information

NPI: 1932525359
Provider Name (Legal Business Name): JANET AMUNDSON MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2014
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1726 S WASHINGTON ST STE 33A
GRAND FORKS ND
58201-6395
US

IV. Provider business mailing address

1201 25TH ST S
FARGO ND
58103-2311
US

V. Phone/Fax

Practice location:
  • Phone: 701-746-4584
  • Fax: 651-925-0057
Mailing address:
  • Phone: 701-451-4900
  • Fax: 651-925-0057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC00738
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number866-3-1-16-279
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: