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General NPI Number Information
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NPI Number | 1285303909
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Entity Type | Individual
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Provider Name | AMANDA FOWLER LSWAIC
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Gender | Female
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Dates
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Enumeration Date | 09/07/2021
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Last Update Date | 09/07/2021
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Provider Practice Location Address
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Address Line | 2330 EASTGATE ST STE 105
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City | WALLA WALLA
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State | WA
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Zip | 99362-1559
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Country | US
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Telephone | 509-973-5788
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Fax |
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Provider Business Mailing Address
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Address Line | 603 E MAPLE ST
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City | WALLA WALLA
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State | WA
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Zip | 99362-4203
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SC61201957
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License Number State | WA
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