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General NPI Number Information
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NPI Number | 1649671504
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Entity Type | Individual
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Provider Name | JO NELL AMBURGEY
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Gender | Female
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Dates
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Enumeration Date | 09/10/2014
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Last Update Date | 09/10/2014
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Provider Practice Location Address
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Address Line | 298 S MAIN ST SUITE L3
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City | COLVILLE
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State | WA
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Zip | 99114-2447
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Country | US
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Telephone | 509-675-0642
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Fax | 509-738-2561
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Provider Business Mailing Address
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Address Line | PO BOX 513
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City | KETTLE FALLS
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State | WA
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Zip | 99141-0513
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Country | US
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Telephone | 509-675-0642
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Fax | 509-738-2561
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW00007912
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License Number State | WA
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