Healthcare Provider Details

I. General information

NPI: 1417588856
Provider Name (Legal Business Name): AMANDA EUN JEE WEBRECK PHD, MS, BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 WESTRIDGE RD STE 103
SOMERSET PA
15501-1157
US

IV. Provider business mailing address

1229 WHITE HORSE RD
BERLIN PA
15530-5614
US

V. Phone/Fax

Practice location:
  • Phone: 814-444-9696
  • Fax:
Mailing address:
  • Phone: 910-546-4175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: