Provider Demographics
NPI:1922794171
Name:GREEN, AMANDA LEIGH
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:LEIGH
Last Name:GREEN
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 1:2365 MCKNIGHT RD N
Mailing Address - Street 2:
Mailing Address - City:NORTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2238
Mailing Address - Country:US
Mailing Address - Phone:651-760-3236
Mailing Address - Fax:651-222-6025
Practice Address - Street 1:2365 MCKNIGHT RD N
Practice Address - Street 2:
Practice Address - City:NORTH ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109-2238
Practice Address - Country:US
Practice Address - Phone:651-760-3236
Practice Address - Fax:651-222-6025
Is Sole Proprietor?:No
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker