Provider Demographics
NPI:1063853836
Name:BURGOD, AMANDA LYNN (LMSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:BURGOD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 AURORA AVE
Mailing Address - Street 2:STE 103E
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-6338
Mailing Address - Country:US
Mailing Address - Phone:515-401-6886
Mailing Address - Fax:515-401-7856
Practice Address - Street 1:3811 38TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-3648
Practice Address - Country:US
Practice Address - Phone:515-450-7478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA008217104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker