Provider Demographics
NPI:1104160761
Name:SYLVESTER, AMANDA RAE (MSW, CMHS, LICSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:RAE
Last Name:SYLVESTER
Suffix:
Gender:F
Credentials:MSW, CMHS, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8927 W TUCANNON AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7176
Mailing Address - Country:US
Mailing Address - Phone:509-737-7052
Mailing Address - Fax:509-619-0223
Practice Address - Street 1:8927 W TUCANNON AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7176
Practice Address - Country:US
Practice Address - Phone:509-737-7052
Practice Address - Fax:509-619-0223
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW601344091041C0700X
WA394375J1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA12356553OtherCAQH PROVIDER ID