Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Amanda Marie Blake, LICSW, MSSW

Individual provider Social Worker · NPI 1174773469

Amanda Marie Blake, LICSW, MSSW is a Clinical Social Worker in Grand Forks, North Dakota. Qualified in 2002, 24 years ago. Practices with Lipp Carlson Witucki and Associates Ltd, a 10-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in North Dakota and Texas.

Years since qualifying
24
Licensed in
ND, TX
In the registry since
2008
Specialties on file
3
What do these letters mean?
LICSW — Licensed Independent Clinical Social Worker
The title some states use for an independently practising clinical social worker.

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Practice location Address checks out

2808 17th Ave S
Grand Forks, ND 58201-4010
Phone: (701) 738-8363
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 412 Demers Ave, Grand Forks, ND 58201-4508 — (701) 787-7728

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 4753 (ND)
Social Worker Taxonomy 104100000X · Licence 4753 (ND)
Social Worker Taxonomy 104100000X · Licence 50864 (TX)

Record details

NPI number1174773469
Entity typeIndividual (Type 1)
GenderFemale
Credentials LICSW , MSSW
Sole proprietorNo
NPI enumeratedSeptember 24, 2008
Last updated in NPPESOctober 31, 2022
Certification dateOctober 31, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2002 (24 years in practice)
Group practice Lipp Carlson Witucki And Associates Ltd — 10 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Other providers in Grand Forks