Healthcare Provider Details

I. General information

NPI: 1336491604
Provider Name (Legal Business Name): AMY J NORTROM LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63360 NW BRITTA STREET BLDG 1
BEND OR
97703
US

IV. Provider business mailing address

63360 BRITTA ST STE 1
BEND OR
97701-9475
US

V. Phone/Fax

Practice location:
  • Phone: 541-316-0269
  • Fax:
Mailing address:
  • Phone: 541-316-0269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number22-06-30037
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC2134
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: