Amanda Rae Radtke, MSW, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

22551 Issued in MN

Practice address

40 11TH St
Cloquet, MN 55720-1817

Phone

(218) 879-4559

Fax

(218) 879-0282

NPI assigned

Dec 16, 2015

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

Other names 1

• Amanda Rae Ostby Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.qualifacts.org/api/fhir/humandevelopmentcenter/r4/

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.

• Brightwater Health Dba Human Development Center

  • Community/Behavioral Health Agency
  • Cloquet, MN
  • NPI 1114048527
  NPD (past)
• Brightwater Health Dba Human Development Center

  • Community/Behavioral Health Agency
  • Grand Marais, MN
  • NPI 1205957610
  NPD (past)

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

{
    "created_epoch": "1450224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450224000000",
    "number": "1679938724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 E 1ST ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558052407",
            "telephone_number": "218-728-4491",
            "fax_number": "218-728-4404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 11TH ST",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "557201817",
            "telephone_number": "218-879-4559",
            "fax_number": "218-879-0282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADTKE",
        "first_name": "AMANDA",
        "middle_name": "RAE",
        "credential": "MSW, LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-16",
        "last_updated": "2015-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "22551",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "OSTBY",
            "middle_name": "RAE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jessica Powers, PA-C
• Robert Allan Precord
• Proctor Isd 704
• Danielle Prom, DPT
• Joseph Urban Quade, P.T.
• Emily Ramsey, LGSW
• Kevin Randa, LPCC
• Maureen Lee Randall, CNP
• Jeffrey B Rapp, M.D.
• Cassandra Rachelle Reponen

• Clinical Social Worker in Cloquet, MN
• Providers in Cloquet, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2015; 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.