Provider Demographics
NPI:1215307244
Name:BENNETT, AMANDA (MSW, CSWA)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MSW, CSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 PATRICK RD
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-9158
Mailing Address - Country:US
Mailing Address - Phone:415-761-9377
Mailing Address - Fax:
Practice Address - Street 1:342 PATRICK RD
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-9158
Practice Address - Country:US
Practice Address - Phone:541-761-9377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-02
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
ORA135381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No174400000XOther Service ProvidersSpecialist