Healthcare Provider Details

I. General information

NPI: 1477987089
Provider Name (Legal Business Name): MRS. AMANDA ANN BOYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2013
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 N 2ND STREET
YAKIMA WA
98902
US

IV. Provider business mailing address

120 S 3RD ST SUITE 100
YAKIMA WA
98901-2875
US

V. Phone/Fax

Practice location:
  • Phone: 509-469-9366
  • Fax:
Mailing address:
  • Phone: 509-575-8457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP 00006181
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: