Provider Demographics
NPI:1124398748
Name:WINDYK, AMANDA JILL (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JILL
Last Name:WINDYK
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5995 OREN AVE N STE 203
Mailing Address - Street 2:
Mailing Address - City:OAK PARK HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55082-6379
Mailing Address - Country:US
Mailing Address - Phone:651-217-1480
Mailing Address - Fax:
Practice Address - Street 1:7401 METRO BLVD STE 203
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-3025
Practice Address - Country:US
Practice Address - Phone:651-217-1480
Practice Address - Fax:833-972-5926
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN197981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical