Healthcare Provider Details

I. General information

NPI: 1457205734
Provider Name (Legal Business Name): AMANDA NELSON
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6210 75TH ST W STE 100
LAKEWOOD WA
98499-8303
US

IV. Provider business mailing address

15404 218TH ST SE
MONROE WA
98272-9162
US

V. Phone/Fax

Practice location:
  • Phone: 425-328-9745
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC61189914
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: