Amanda Rose Donnelly, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP6790 Issued in MN

Practice address

11855 Ulysses St NE
Blaine, MN 55434-3947

Phone

(763) 762-9241

NPI assigned

Dec 29, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1609200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672099200000",
    "number": "1760079396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10611 BALTIMORE ST NE UNIT 490412",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554499930",
            "telephone_number": "651-279-3963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11855 ULYSSES ST NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554343947",
            "telephone_number": "763-762-9241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONNELLY",
        "first_name": "AMANDA",
        "middle_name": "ROSE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-12-29",
        "last_updated": "2022-12-27",
        "certification_date": "2022-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "CC00630",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP6790",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caitlin R Dewitt, DPT
• Kirsten Dimatteo, PHARMD
• Doc DJR PC
• Karen Rae Dohman, MA, CCC-SLP
• Don Blakeslee DDS PA
• Laura Elizabeth Dougherty
• Douglas T Jonak DDS PA
• Dr. Andrew Brown Chiropracitc PC
• Dr. Rebecca R. Jackson LLC
• Douglas Alan Drew, MA, LICSW

• Clinical Psychologist in Blaine, MN
• Providers in Blaine, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 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.