Provider Demographics
NPI:1366505935
Name:KNUTSON, AMANDA M (LPCC)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:M
Last Name:KNUTSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 MADISON AVE STE 628
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-5488
Mailing Address - Country:US
Mailing Address - Phone:507-779-7366
Mailing Address - Fax:855-847-9876
Practice Address - Street 1:1400 MADISON AVE STE 628
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5488
Practice Address - Country:US
Practice Address - Phone:507-779-7366
Practice Address - Fax:855-847-9876
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN00433101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1366505935Medicaid