Healthcare Provider Details

I. General information

NPI: 1164952008
Provider Name (Legal Business Name): AMANDA CAROLINE HOAG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 06/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 S 3RD ST
RENTON WA
98057-2765
US

IV. Provider business mailing address

PO BOX 1510
RENTON WA
98057-1510
US

V. Phone/Fax

Practice location:
  • Phone: 425-271-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: