Provider Demographics
NPI:1437609328
Name:AMUNDSON, RICHELLE RENEE (LICSW)
Entity type:Individual
Prefix:
First Name:RICHELLE
Middle Name:RENEE
Last Name:AMUNDSON
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 1:10721 TYLER CT NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-3297
Mailing Address - Country:US
Mailing Address - Phone:612-208-3721
Mailing Address - Fax:
Practice Address - Street 1:9298 CENTRAL AVE NE STE 406
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-4220
Practice Address - Country:US
Practice Address - Phone:612-208-3721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2024-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN234931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical