Amanda Grace McKnelly, CCDCIII

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

11091490 Issued in SD

Practice address

2412 S Cliff Ave
Ste 100
Sioux Falls, SD 57105-4031

Phone

(605) 322-4079

Fax

(605) 322-4080

NPI assigned

Oct 18, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Avera McKennan

  dba Avera Gregory Hospital

  • Critical Access Hospital
  • Gregory, SD
  • NPI 1275562027
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1350518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350518400000",
    "number": "1427301191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 S PRAIRIE AVE",
            "city": "TEA",
            "state": "SD",
            "postal_code": "570643216",
            "telephone_number": "605-322-4079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2412 S CLIFF AVE",
            "address_2": "STE 100",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571054031",
            "telephone_number": "605-322-4079",
            "fax_number": "605-322-4080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKNELLY",
        "first_name": "AMANDA",
        "middle_name": "GRACE",
        "credential": "CCDCIII",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-18",
        "last_updated": "2012-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "SD",
            "license": "11091490",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Benjamin James McKinley, M.D.
• Caleb E McKinley, DDS
• Ethan William McKinney
• Karlee McKinney, ATC
• Kris Dale McKinney, D.D.S.
• Kelly N McKnight Purcell, MD
• Rachel McLaughlin, RN
• Michael Paul McLaury, PA
• Alyssa Marjorie McLellan, MS, RD, LD
• Alec Ian McLeod

• Addiction (Substance Use Disorder) Counselor in Sioux Falls, SD
• Providers in Sioux Falls, SD by specialty
• Addiction (Substance Use Disorder) Counselor in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.