Individual
AMANDA ICENHOWER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
8495 CRATER LAKE HWY, 11CM, WHITE CITY, OR 97503-3011
(541) 826-2111
Mailing address
8495 CRATER LAKE HWY, WHITE CITY, OR 97503-3011
(541) 826-2111
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
A4107
OR
1041C0700X
Clinical Social Worker
L7414
OR
Other
Enumeration date
04/01/2016
Last updated
04/02/2018
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