Amanda Marie Wallace, LCSW
Individual provider Active NPI Case Manager/Care Coordinator · Mohall, ND
NPI 1952808024 · NPPES record last updated Apr 6, 2018
Key facts
- NPI
- 1952808024
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Case Manager/Care Coordinator 171M00000X
- License
- 4524 (ND)
- Practice address
- 205 Main St E
Mohall, ND 58761-4014 - Phone
- (701) 756-6374
- NPI assigned
- Apr 6, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4524 | ND | MD | Case Manager/Care Coordinator |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Renville County Social Services | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | 4524 | ND | Yes |
Addresses
Primary practice location
205 Main St E
Mohall, ND 58761-4014
Mailing address
PO Box 305
Mohall, ND 58761-0305
Phone (701) 756-6374
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1473894 | Medicaid | ND |
Other providers in Mohall, ND
- Melanie Ray Skar
- Mary Smith
- Ruth A Stanley
- The Evangelical Lutheran Good Samaritan Society
- Sarah Irene Tracy
- White Drug Co of Jamestown Inc
All providers in Mohall, ND · Case Manager/Care Coordinator in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 6, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.