Individual
AMANDA MARIE JOHNSTON-PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRPA-P
Contact information
Practice address
31 THURBER DR, WATERLOO, NY 13165-1665
(315) 539-1985
(315) 539-4393
Mailing address
18 FAYETTE ST, WATERLOO, NY 13165-1708
(315) 539-1957
(315) 539-4393
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
09/05/2019
Last updated
09/05/2019
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