Provider Demographics
NPI:1508684655
Name:FREED, AMANDA Z (LAC)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:Z
Last Name:FREED
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 S DEEP LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55127-6312
Mailing Address - Country:US
Mailing Address - Phone:612-296-3796
Mailing Address - Fax:
Practice Address - Street 1:49 S DEEP LAKE RD
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55127-6312
Practice Address - Country:US
Practice Address - Phone:612-296-3796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2089171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist