Individual
AMANDA R WEYRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11666 N 28TH DR, UNIT 165, PHOENIX, AZ 85029-5616
(602) 279-1427
(602) 279-1431
Mailing address
PO BOX 16906, PHOENIX, AZ 85011-6906
(602) 279-1427
(602) 279-1431
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
7653883
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7653883
DCS/OLR LICENSING AUTHORITY
AZ
Enumeration date
05/11/2017
Last updated
05/11/2017
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