Individual
AMANDA WAGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, MHP
Contact information
Practice address
204 NE 94TH STREET, SEATTLE, WA 98115-2727
(206) 461-4580
Mailing address
15622 36TH AVE NE, LAKE FOREST PARK, WA 98155-6616
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/07/2016
Last updated
09/07/2016
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