Individual
AMANDA ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
1611 COUNTY ROAD B W STE 214, ROSEVILLE, MN 55113-4053
(651) 217-8600
Mailing address
1611 COUNTY ROAD B W STE 214, ROSEVILLE, MN 55113-4053
(651) 217-8600
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
25258
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H300322582
NGS MEDICARE
MN
Enumeration date
06/14/2016
Last updated
11/20/2025
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