Individual
AMY VREDENBURGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., L.M.F.T.
Contact information
Practice address
905 STANLEY AVE, CLOQUET, MN 55720-3186
(612) 876-6586
(218) 585-1586
Mailing address
9450 SW GEMINI DR, PMB 14034, BEAVERTON, OR 97008
(612) 876-6586
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
2962
MN
106H00000X
Marriage & Family Therapist
Primary
2962
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L232112102607
MINNESOTA LISCENCE
MN
Enumeration date
04/08/2015
Last updated
06/02/2021
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