Provider Demographics
NPI:1902661242
Name:STREDICKE, AMANDA R (CMA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:R
Last Name:STREDICKE
Suffix:
Gender:F
Credentials:CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4909 108TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3724
Mailing Address - Country:US
Mailing Address - Phone:253-544-4772
Mailing Address - Fax:
Practice Address - Street 1:3405 ERICKSON ST APT B7
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1288
Practice Address - Country:US
Practice Address - Phone:253-255-5279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other