Individual
AMANDA WATTERS-LOEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10508 275TH AVE NW, ZIMMERMAN, MN 55398-4377
(218) 410-1486
(651) 389-9492
Mailing address
10508 275TH AVE NW, ZIMMERMAN, MN 55398-4377
(218) 410-1486
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A186485400
—
MN
Enumeration date
01/04/2023
Last updated
01/04/2023
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