Provider Demographics
NPI:1144503343
Name:KERN, AMANDA
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:KERN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 E MAIN ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:OTHELLO
Mailing Address - State:WA
Mailing Address - Zip Code:99344-1146
Mailing Address - Country:US
Mailing Address - Phone:509-488-4074
Mailing Address - Fax:509-488-0166
Practice Address - Street 1:425 E MAIN ST
Practice Address - Street 2:SUITE 600
Practice Address - City:OTHELLO
Practice Address - State:WA
Practice Address - Zip Code:99344-1146
Practice Address - Country:US
Practice Address - Phone:509-488-4074
Practice Address - Fax:509-488-0166
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health