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Provider Information for 1245837541

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

AMANDA ANN GOMEZ LICSW

Other Name:   AMANDA MARKOWSKI
Gender: FEMALE

Individual NPI: 1245837541

Calendar   Last Updated:  2020-10-08
  Certification Date:  2020-10-08

Details

Name Value
NPI 1245837541
Enumeration Date 2020-10-08
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 621 W LAKE ST STE 350
MINNEAPOLIS, MN 55408-2952
United States

Phone: | Fax:
View Map External Link
Primary Practice Address 3112 HENNEPIN AVE
MINNEAPOLIS, MN 55408-2619
United States

Phone: 612-395-4967 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1041C0700X - Social Worker Clinical MN 21549