1407000490 NPI number — JODI LYNN AMDAHL ADT/RDH

Table of content: JODI LYNN AMDAHL ADT/RDH (NPI 1407000490)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407000490 NPI number — JODI LYNN AMDAHL ADT/RDH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMDAHL
Provider First Name:
JODI
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ADT/RDH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAGER
Provider Other First Name:
JODI
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ADT/RDH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1407000490
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 4TH STREET, PO BOX 272
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALATON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-276-1115
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
590 W PARK ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDWOOD FALLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56283
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-637-3581
Provider Business Practice Location Address Fax Number:
507-627-8894
Provider Enumeration Date:
11/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 124Q00000X , with the licence number:  H7202 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 125K00000X , with the licence number: DT5 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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