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General NPI Number Information
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NPI Number | 1295616399
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Entity Type | Individual
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Provider Name | AMANDA SMITH
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Gender | Female
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Dates
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Enumeration Date | 09/08/2025
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 125 S SIBLEY AVE STE 5
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City | LITCHFIELD
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State | MN
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Zip | 55355-2831
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Country | US
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Telephone | 320-535-2176
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Fax |
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Provider Business Mailing Address
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Address Line | 43806 410TH AVE
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City | HERON LAKE
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State | MN
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Zip | 56137-2051
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Country | US
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Telephone | 320-221-0391
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 34908
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License Number State | MN
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