MEDICARE: AMANDA OCKERT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	174400000X	Specialist	00000	MN
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	1838	ND

General Provider Information

NPI Number	:	1891245759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA OCKERT

Provider Business Mailing Address
First Line	:	2624 9TH AVE S
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58103-2350
Country	:	US
Telephone Number	:	701-298-4500
Fax Number	:	701-298-4400

Provider Business Practice Location Address
First Line	:	1126 WESTRAC DR S
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58103-2342
Country	:	US
Telephone Number	:	701-412-2973
Fax Number	:	701-237-4407

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2016
Last Update Date	:	09/09/2020

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Directions to “ AMANDA OCKERT ” Practice Location

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