Provider Demographics
NPI:1528837028
Name:RICHARDS, AMBER (CRM II, PWS, THW)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:CRM II, PWS, THW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 NW 8TH AVE APT 903
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3790
Mailing Address - Country:US
Mailing Address - Phone:503-312-1313
Mailing Address - Fax:
Practice Address - Street 1:112 11TH ST
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1021
Practice Address - Country:US
Practice Address - Phone:971-291-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
ORTHW000106034172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator