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NPI Code Detail

MEDICARE: AMANDA PETERSON MAC

MEDICARE: AMANDA PETERSON MAC
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
1101YP2500XProfessional Counselor2010021554MO

General Provider Information

NPI Number : 1689986622
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA PETERSON MAC
Provider Business Mailing Address
First Line : 902 11TH AVE
Second Line :
City : FOX ISLAND
State : WA
Zip : 98333-9689
Country : US
Telephone Number : 618-365-3494
Fax Number :
Provider Business Practice Location Address
First Line : 6512 23RD AVE NW
Second Line :
City : SEATTLE
State : WA
Zip : 98117-5728
Country : US
Telephone Number : 206-502-5941
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2010
Last Update Date : 10/28/2022

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Directions to “ AMANDA PETERSON MAC” Practice Location

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