Provider Demographics
NPI:1114429727
Name:BARTLETT, AMANDA LYNNE
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNNE
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LYNNE
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9288 KRISTINE DR NW
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-9011
Mailing Address - Country:US
Mailing Address - Phone:360-865-9520
Mailing Address - Fax:
Practice Address - Street 1:9288 KRISTINE DR NW
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-9011
Practice Address - Country:US
Practice Address - Phone:360-865-9520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-28
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician