Provider Demographics
NPI:1548776479
Name:FEY, AMANDA (EDS)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:FEY
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 W CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:BERESFORD
Mailing Address - State:SD
Mailing Address - Zip Code:57004-1524
Mailing Address - Country:US
Mailing Address - Phone:605-763-5096
Mailing Address - Fax:605-763-2206
Practice Address - Street 1:1109 W CEDAR ST
Practice Address - Street 2:
Practice Address - City:BERESFORD
Practice Address - State:SD
Practice Address - Zip Code:57004-1524
Practice Address - Country:US
Practice Address - Phone:605-763-5096
Practice Address - Fax:605-763-2206
Is Sole Proprietor?:No
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD78440-0103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist