Healthcare Provider Details

I. General information

NPI: 1235567520
Provider Name (Legal Business Name): AMANDA POFFENBERGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2013
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 W HOOD PL STE 208
KENNEWICK WA
99336-3400
US

IV. Provider business mailing address

1950 KEENE RD BLDG G
RICHLAND WA
99352-7706
US

V. Phone/Fax

Practice location:
  • Phone: 509-438-7741
  • Fax:
Mailing address:
  • Phone: 509-619-0519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLH60747135
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: