Provider Demographics
NPI:1689447245
Name:QUACH, AMANDA H
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:H
Last Name:QUACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 FELTL RD
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-3944
Mailing Address - Country:US
Mailing Address - Phone:952-746-0222
Mailing Address - Fax:
Practice Address - Street 1:10720 ROCKFORD RD APT 215
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55442-2869
Practice Address - Country:US
Practice Address - Phone:763-647-8926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician