Provider Demographics
NPI:1790088409
Name:REDEPENNING, AMANDA L (MA, LMFT)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:L
Last Name:REDEPENNING
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2315 CLINTON AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3660
Mailing Address - Country:US
Mailing Address - Phone:612-709-3506
Mailing Address - Fax:
Practice Address - Street 1:11334 86TH AVE N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4528
Practice Address - Country:US
Practice Address - Phone:763-255-2125
Practice Address - Fax:763-255-2126
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-20
Last Update Date:2011-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1945106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist