Provider Demographics
NPI:1982193454
Name:HIRD, AMANDA MAE (LICSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MAE
Last Name:HIRD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 S. 5TH ST.
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001
Mailing Address - Country:US
Mailing Address - Phone:507-304-4319
Mailing Address - Fax:507-304-4160
Practice Address - Street 1:410 S. 5TH ST.
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001
Practice Address - Country:US
Practice Address - Phone:507-304-4319
Practice Address - Fax:507-304-4160
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20237104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker