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NPI Code Detail

MEDICARE: MS. LANETTE KANIKA AMBERS MSW

MEDICARE: MS. LANETTE KANIKA AMBERS MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerL4015OR

General Provider Information

NPI Number : 1396880563
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LANETTE KANIKA AMBERS MSW
Provider Business Mailing Address
First Line : 3529 NE BROADWAY ST STE 201
Second Line :
City : PORTLAND
State : OR
Zip : 97232-1820
Country : US
Telephone Number : 503-317-9632
Fax Number :
Provider Business Practice Location Address
First Line : 3529 NE BROADWAY ST STE 201
Second Line :
City : PORTLAND
State : OR
Zip : 97232-1820
Country : US
Telephone Number : 503-317-9632
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2007
Last Update Date : 10/29/2024

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