Individual
AMANDA LEATHERMAN MACKIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
306 BYRON ST, MANKATO, MN 56001-3846
(507) 344-3360
Mailing address
PO BOX 3032, MANKATO, MN 56002-3032
(507) 344-3360
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
17224
MN
Other
Enumeration date
05/01/2007
Last updated
07/01/2010
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