Healthcare Provider Details

I. General information

NPI: 1679128607
Provider Name (Legal Business Name): AMANDA HODGE CMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 S HILLHURST RD
RIDGEFIELD WA
98642-9854
US

IV. Provider business mailing address

PO BOX 1234
SAINT HELENS OR
97051-8234
US

V. Phone/Fax

Practice location:
  • Phone: 360-887-6060
  • Fax: 360-727-3683
Mailing address:
  • Phone: 503-397-5211
  • Fax: 503-397-5373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: