Provider Demographics
NPI:1730222605
Name:POWERS, AMANDA BERNEDETTE (PSYD LP)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:BERNEDETTE
Last Name:POWERS
Suffix:
Gender:F
Credentials:PSYD LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7373 W 147TH ST
Mailing Address - Street 2:DAKOTA VALLEY PSYCHOLOGISTS STE 180
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124
Mailing Address - Country:US
Mailing Address - Phone:952-432-3220
Mailing Address - Fax:952-891-4622
Practice Address - Street 1:7373 W 147TH ST
Practice Address - Street 2:DAKOTA VALLEY PSYCHOLOGISTS STE 180
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124
Practice Address - Country:US
Practice Address - Phone:952-432-3220
Practice Address - Fax:952-891-4622
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4578103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
435M1P0OtherBCBS
2431289OtherAMERICAS PPO