Provider Demographics
NPI:1972326379
Name:VENEKLASEN, AMANDA KARIN
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:KARIN
Last Name:VENEKLASEN
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 1:505 SE 184TH AVE UNIT 204
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-1937
Mailing Address - Country:US
Mailing Address - Phone:719-291-4064
Mailing Address - Fax:
Practice Address - Street 1:505 SE 184TH AVE UNIT 204
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-1937
Practice Address - Country:US
Practice Address - Phone:719-291-4064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical