Provider Demographics
NPI:1093209413
Name:NIELSON, AMY L (LSWAIC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:NIELSON
Suffix:
Gender:F
Credentials:LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 GRAY LYNN DR
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-9245
Mailing Address - Country:US
Mailing Address - Phone:509-386-6154
Mailing Address - Fax:
Practice Address - Street 1:1760 GRAY LYNN DR
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-9245
Practice Address - Country:US
Practice Address - Phone:509-386-6154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical