Provider Demographics
NPI:1568839215
Name:WRUBLE, AMANDA (BA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:WRUBLE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 TREAT AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-5234
Mailing Address - Country:US
Mailing Address - Phone:451-641-8000
Mailing Address - Fax:
Practice Address - Street 1:1200 HILYARD ST STE 420
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8161
Practice Address - Country:US
Practice Address - Phone:458-205-6444
Practice Address - Fax:458-205-6440
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OR24-QMHPC-001405101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor