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General NPI Number Information
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NPI Number | 1811640873
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Entity Type | Individual
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Provider Name | AMANDA BROOKE WALKER CRM
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Gender | Female
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Dates
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Enumeration Date | 01/31/2022
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 627 NE EVANS ST
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City | MCMINNVILLE
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State | OR
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Zip | 97128-3923
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Country | US
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Telephone | 503-434-7527
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Fax |
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Provider Business Mailing Address
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Address Line | 12215 BALLSTON RD
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City | AMITY
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State | OR
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Zip | 97101-9517
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Country | US
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Telephone | 971-312-3992
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 23-06-10792
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License Number State | OR
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