Healthcare Provider Details

I. General information

NPI: 1285411926
Provider Name (Legal Business Name): AMANDA NEAL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 EXCHANGE ST
ASTORIA OR
97103-3329
US

IV. Provider business mailing address

1533 SE HONEYSUCKLE LOOP UNIT B
WARRENTON OR
97146-7421
US

V. Phone/Fax

Practice location:
  • Phone: 503-325-4321
  • Fax:
Mailing address:
  • Phone: 331-684-5662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL11304
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: