Healthcare Provider Details

I. General information

NPI: 1215307244
Provider Name (Legal Business Name): AMANDA BENNETT MSW, CSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2015
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 PATRICK RD
GRANTS PASS OR
97527-9158
US

IV. Provider business mailing address

342 PATRICK RD
GRANTS PASS OR
97527-9158
US

V. Phone/Fax

Practice location:
  • Phone: 541-761-9377
  • Fax:
Mailing address:
  • Phone: 415-761-9377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL16788
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

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: