Individual
AMANDA MAE SICKENGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1001 W BROADWAY, SUITE D, FARMINGTON, NM 87401-5638
(505) 326-8695
Mailing address
1700 CLIFFSIDE DR APT 207, FARMINGTON, NM 87401-4341
(505) 386-6211
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
44933
—
NM
Enumeration date
12/18/2015
Last updated
12/30/2019
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