MEDICARE: JONELL ILEAN AMACKER PPS

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
1	101YS0200X	School Counselor	210101178	CA

General Provider Information

NPI Number	:	1801596507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONELL ILEAN AMACKER PPS

Provider Business Mailing Address
First Line	:	1135 LINCOLN ST
Second Line	:
City	:	RED BLUFF
State	:	CA
Zip	:	96080-3125
Country	:	US
Telephone Number	:	530-528-7303
Fax Number	:

Provider Business Practice Location Address
First Line	:	1135 LINCOLN ST
Second Line	:
City	:	RED BLUFF
State	:	CA
Zip	:	96080-3125
Country	:	US
Telephone Number	:	530-528-7303
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2023
Last Update Date	:	02/06/2026

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