Active NPI
Amanda Luedtke, LPCC
- Professional Counselor
- Minneapolis, MN
National Provider Identifier
1023435690
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- CC00887
- Practice address
- 2400 Park Ave
Minneapolis, MN 55404 - Phone
- (612) 879-5320
- Fax
- (612) 879-5282
- NPI assigned
- Mar 21, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | CC00887 | MI | Primary |
Addresses
Primary practice location
2400 Park Ave
Minneapolis, MN 55404
Mailing address
510 Ellis LN
Golden Valley, MN 55427-4801
Phone (651) 263-1219
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CC00887 | MI | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lutheran Social Service of Minnesota | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Saint Cloud, MN
- NPI 1629192430
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1395360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528416000000",
"number": "1023435690",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "510 ELLIS LN",
"city": "GOLDEN VALLEY",
"state": "MN",
"postal_code": "554274801",
"telephone_number": "651-263-1219"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2400 PARK AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "55404",
"telephone_number": "612-879-5320",
"fax_number": "612-879-5282"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUEDTKE",
"first_name": "AMANDA",
"credential": "LPCC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-03-21",
"last_updated": "2018-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MI",
"license": "CC00887",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.