Amanda Ellis,LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LICSW Issued in MN

Legal business name

AMANDA ELLIS,LLC

Practice address

2960 Snelling Ave N Ste 210
Roseville, MN 55113-2458

Phone

(651) 217-8600

NPI assigned

Jun 18, 2017

Organization subpart

No

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

Authorized official

Name

Amanda Ellis, LICSWNPI 1245680925

Title

Owner

Phone

(651) 217-8600

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Amanda Ellis, LICSW

  • Clinical Social Worker
  • Edina, MN
  • NPI 1245680925

  Clinical

  NPD (past) Authorized official

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

{
    "created_epoch": "1497744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1699205146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2960 SNELLING AVE N STE 210",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551132458",
            "telephone_number": "651-217-8600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2960 SNELLING AVE N STE 210",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551132458",
            "telephone_number": "651-217-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMANDA ELLIS,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-18",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-217-8600",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "LICSW",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Roseville, MN
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.