Healthcare Provider Details

I. General information

NPI: 1265229975
Provider Name (Legal Business Name): AMANDA BARDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2025
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10740 MERIDIAN AVE N
SEATTLE WA
98133-9010
US

IV. Provider business mailing address

62 W KIMBERLY DR
FORT THOMAS KY
41075-1229
US

V. Phone/Fax

Practice location:
  • Phone: 425-578-5144
  • Fax:
Mailing address:
  • Phone: 859-750-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: