Provider Demographics
NPI:1154851574
Name:AMODIO, AIMEE (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:
Last Name:AMODIO
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14523 SE GLADSTONE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-2491
Mailing Address - Country:US
Mailing Address - Phone:360-836-0725
Mailing Address - Fax:
Practice Address - Street 1:14523 SE GLADSTONE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-2491
Practice Address - Country:US
Practice Address - Phone:360-836-0725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-18
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALW61091991OtherWA DEPT OF HEALTH
ORA4961OtherOR BOARD OF LICENSED SOCIAL WORKERS