Provider Demographics
NPI:1861708539
Name:BORDE, AMANDA DAWN MARIA (MSW, BA)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:DAWN MARIA
Last Name:BORDE
Suffix:
Gender:F
Credentials:MSW, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4536 41ST AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-4011
Mailing Address - Country:US
Mailing Address - Phone:612-839-8809
Mailing Address - Fax:
Practice Address - Street 1:2616 NICOLLET AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-1628
Practice Address - Country:US
Practice Address - Phone:612-238-2320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical