Individual
AMANDA MARIE DOUGHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9358 ENSIGN AVE S, BLOOMINGTON, MN 55438-1472
(952) 666-2289
Mailing address
9358 ENSIGN AVE S, BLOOMINGTON, MN 55438-1472
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
05/21/2024
Last updated
05/21/2024
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