Provider Demographics
NPI:1386133072
Name:FLANSCHA-JACOBSON, AMANDA NICOLE (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:NICOLE
Last Name:FLANSCHA-JACOBSON
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 5TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ISANTI
Mailing Address - State:MN
Mailing Address - Zip Code:55040-2205
Mailing Address - Country:US
Mailing Address - Phone:763-688-9700
Mailing Address - Fax:
Practice Address - Street 1:300 5TH AVE NE
Practice Address - Street 2:
Practice Address - City:ISANTI
Practice Address - State:MN
Practice Address - Zip Code:55040-2205
Practice Address - Country:US
Practice Address - Phone:763-688-9700
Practice Address - Fax:763-688-9701
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN34622255A2300X
WI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer