Healthcare Provider Details

I. General information

NPI: 1669148169
Provider Name (Legal Business Name): AMANDA KLING LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 COMMERCE PARK DR STE 110
WILLIAMSPORT PA
17701-5475
US

IV. Provider business mailing address

PO BOX 597
MOUNTVILLE PA
17554-0597
US

V. Phone/Fax

Practice location:
  • Phone: 570-323-6944
  • Fax: 570-323-4529
Mailing address:
  • Phone: 570-323-6944
  • Fax: 570-323-4529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW134509
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: