AMANDA MARIE BLAKE LICSW, MSSW
NPI 1174773469
Social Worker - Clinical in Grand Forks, ND

Q: What is Amanda Blake's NPI number?

The NPI number for Amanda Blake is 1174773469. It was assigned to this individual provider in the NPPES registry on September 24, 2008. The provider is also known as Amanda Jimenez Lcsw, Mssw.

Q: What is Amanda Blake's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Q: When was this NPI record last updated?

The NPPES record for Amanda Blake was last updated on October 31, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since September 24, 2008PECOS EnrolledAccepts Medicare Assignment

2808 17TH AVE S, GRAND FORKS, ND 58201(701) 738-8363 Get Directions Write a Review

NPPES record last updated: October 31, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Oct 31, 2022, Mar 17, 2018, Nov 8, 2017 (3 updates tracked since 2017).

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About Amanda Marie Blake Licsw, Mssw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AMANDA MARIE BLAKE LICSW, MSSW (NPI 1174773469) is an individual clinical provider in Grand Forks, North Dakota, licensed in North Dakota (4753) and active in the NPI registry since September 2008. She is enrolled in Medicare PECOS, maintains a secondary practice location in Grand Forks, and is a graduate of Other (2002).

NPPES Registry Identity

NPI1174773469

Entity TypeIndividualFemale

Primary Taxonomy1041C0700X

Provider Legal NameAMANDA MARIE BLAKECredential: LICSW, MSSW

Location Address2808 17TH AVE SGrand Forks, ND 58201-4010

Mailing Address2808 17th Ave SGrand Forks, ND 58201-4010 · (701) 746-8376

Phone(701) 738-8363

Sole ProprietorNo

Medical School CMSOtherGraduated 2002

Enumeration DateSeptember 24, 2008

Last NPPES UpdateOctober 31, 20223 updates tracked since enumeration

NPPES CertifiedOctober 31, 2022

✔ NPI 1174773469 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code1041C0700X

License✔ Licensed in ND · 4753

Definition

A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.

Also ListedSocial WorkerTaxonomy 104100000X · License 4753 (ND), 50864 (TX)

2808 17TH AVE S, Grand Forks, ND 58201

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Other Names 1

Former Name (1)Amanda Jimenez Lcsw, Mssw

Secondary Practice Location 1

Location 1412 DeMers AveGrand Forks, ND 58201-4508 · Phone (701) 787-7728

Other Identifiers 1

Medicaid1464225ND

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross Blue Shield of North Dakota, Medica, Providence Health Plan and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Amanda Marie Blake Licsw, Mssw is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7810262243

PECOS Enrollment IDI20171010002901

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 58201 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$0.00 typical visit price

range $55.75 – $168.12

Typical copayment $0.00 (range $13.93 – $42.03)

Most-billed visit code NA

Established Patient

$69.48 typical visit price

range $18.11 – $137.65

Typical copayment $17.37 (range $4.52 – $34.41)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 15

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. JONATHAN E WHALEN PH.D.

Psychologist (Clinical)