Individual
JO NELL AMBURGEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
298 S MAIN ST, SUITE L3, COLVILLE, WA 99114-2447
(509) 675-0642
(509) 738-2561
Mailing address
PO BOX 513, KETTLE FALLS, WA 99141-0513
(509) 675-0642
(509) 738-2561
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LW00007912
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
09/10/2014
Last updated
09/10/2014
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