Provider Demographics
NPI:1003054545
Name:MULFINGER, AMANDA
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:MULFINGER
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 1:7301 OHMS LN STE 450
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2339
Mailing Address - Country:US
Mailing Address - Phone:952-831-2000
Mailing Address - Fax:952-835-6134
Practice Address - Street 1:7301 OHMS LN STE 450
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2339
Practice Address - Country:US
Practice Address - Phone:952-831-2000
Practice Address - Fax:952-835-6134
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
MN5029103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNLP5029OtherMINNESOTA BOARD OF PSYCHOLOGY