Individual
AMANDA GRACE MCKNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCDCIII
Contact information
Practice address
2412 S CLIFF AVE, STE 100, SIOUX FALLS, SD 57105-4031
(605) 322-4079
(605) 322-4080
Mailing address
720 S PRAIRIE AVE, TEA, SD 57064-3216
(605) 322-4079
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
11091490
SD
Other
Enumeration date
10/18/2012
Last updated
10/18/2012
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