Individual
AMANDA LOUISE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1218 N DIVISION AVE STE 217, SANDPOINT, ID 83864-5054
(208) 610-6459
(208) 694-2139
Mailing address
1317 PROMINENCE CT, SANDPOINT, ID 83864-5412
(208) 610-6459
(208) 694-2139
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
LMSW36080
ID
1041C0700X
Clinical Social Worker
Primary
LCSW-38205
ID
Other
Enumeration date
10/12/2016
Last updated
03/05/2024
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