Individual
AMANDA KISTNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5415 SW WESTGATE DR, PORTLAND, OR 97221-2409
(503) 645-3581
Mailing address
8915 SW CENTER ST, TIGARD, OR 97223-6307
(503) 726-3690
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
09/06/2024
Last updated
03/30/2026
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