Amanda Marie Wallace, LCSW
Case Manager/Care Coordinator in Mohall, ND. Individual provider (NPI-1).
NPI number1952808024
StatusActive
Last updated in NPPESApr 6, 2018
Details
- NPI
- 1952808024
- Entity type
- Individual (NPI-1)
- Name
- Amanda Marie Wallace
- Credential
- LCSW
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Apr 6, 2018
- Last updated
- Apr 6, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 171M00000X | Case Manager/Care Coordinator | 4524 | ND | Yes |
Practice location
205 Main St EMohall, ND 58761-4014
Phone 701-756-6374
Mailing address
Po Box 305Mohall, ND 58761-0305
Phone 701-756-6374
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