Organization
AMANDA VASKE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. AMANDA VASKE MA, LMFT (OWNER)
(651) 329-1266
Entity
Organization
Contact information
Practice address
1310 HIGHWAY 96 E, WHITE BEAR LAKE, MN 55110-3624
(651) 329-1266
Mailing address
1310 HIGHWAY 96 E STE 211, WHITE BEAR LAKE, MN 55110-3619
(651) 329-1266
(651) 846-5312
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103TC1900X
Counseling Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063696300
—
MN
Enumeration date
09/25/2017
Last updated
10/23/2017
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