Provider Demographics
NPI:1073235792
Name:STERNER, AMANDA MAY (RECOVERY COACH)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MAY
Last Name:STERNER
Suffix:
Gender:F
Credentials:RECOVERY COACH
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:STERNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:THOMASON
Mailing Address - Street 1:5977 SKY RANCH RD
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-9161
Mailing Address - Country:US
Mailing Address - Phone:208-466-8394
Mailing Address - Fax:
Practice Address - Street 1:5977 SKY RANCH RD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-9161
Practice Address - Country:US
Practice Address - Phone:208-466-8394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID13059175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID13059Medicaid