Provider Demographics
NPI:1215413570
Name:ANDERSON, AMY BETH (PSS,CHW, PWS)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:BETH
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PSS,CHW, PWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3735 SE SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-5855
Mailing Address - Country:US
Mailing Address - Phone:971-271-7182
Mailing Address - Fax:
Practice Address - Street 1:3735 SE SHERMAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-5855
Practice Address - Country:US
Practice Address - Phone:971-271-7182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR172V00000X, 175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No172V00000XOther Service ProvidersCommunity Health Worker