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General NPI Number Information
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NPI Number | 1922772383
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Entity Type | Individual
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Provider Name | BRITTNI AMANDA INGVALDSON
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Gender | Female
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Dates
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Enumeration Date | 08/08/2021
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 17645 JUNIPER PATH STE 105
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City | LAKEVILLE
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State | MN
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Zip | 55044-7491
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Country | US
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Telephone | 952-600-8191
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Fax |
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Provider Business Mailing Address
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Address Line | 5241 LINCOLN DR APT 113
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City | EDINA
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State | MN
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Zip | 55436-2701
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Country | US
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Telephone | 507-363-1672
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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 | 04654
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 304240
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License Number State | MN
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