Individual
MS. AMY MICHELLE ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
233 SW WILSON AVE, STE 201, BEND, OR 97702
(541) 382-8862
Mailing address
233 SW WILSON AVE STE 201, BEND, OR 97702-2988
(541) 382-8862
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1225169378
OHP
OR
05
—
1225169378
—
OR
Enumeration date
10/15/2020
Last updated
10/15/2020
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