Individual
AMANDA MACY VANWAGENEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2375 NW GLISAN ST, PORTLAND, OR 97210-3420
(503) 963-7641
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
09/15/2020
Last updated
09/15/2020
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