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General NPI Number Information
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NPI Number | 1346768496
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Entity Type | Individual
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Provider Name | AMANDA OGDAHL
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Gender | Female
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Dates
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Enumeration Date | 09/08/2017
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Last Update Date | 07/31/2019
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Provider Practice Location Address
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Address Line | 324 BROADWAY ST STE 206
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City | ALEXANDRIA
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State | MN
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Zip | 56308-1482
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Country | US
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Telephone | 320-762-1762
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Fax |
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Provider Business Mailing Address
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Address Line | 450 22ND AVE NW
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City | GLENWOOD
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State | MN
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Zip | 56334-4547
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Country | US
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Telephone | 612-325-6707
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CC01552
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License Number State | MN
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