Healthcare Provider Details

I. General information

NPI: 1659280568
Provider Name (Legal Business Name): AMY SUSANNE SAYLER ICCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY S JORDAN

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S CLOVER DR
MOSES LAKE WA
98837-4417
US

IV. Provider business mailing address

2000 S CLOVER DR
MOSES LAKE WA
98837-4417
US

V. Phone/Fax

Practice location:
  • Phone: 509-793-9663
  • Fax: 509-764-3229
Mailing address:
  • Phone: 509-793-9663
  • Fax: 509-764-3229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: