Provider Demographics
NPI:1407976632
Name:MCKEIGNEY-CHILDS, AMANDA BAKER (LCSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:BAKER
Last Name:MCKEIGNEY-CHILDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:CHILDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:401 N 8TH ST # 997
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-3761
Mailing Address - Country:US
Mailing Address - Phone:479-274-8271
Mailing Address - Fax:
Practice Address - Street 1:204 S 24TH ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758
Practice Address - Country:US
Practice Address - Phone:479-621-0301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2018-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR171M00000X
AR6599-C1041C0700X
ARPLMSW104100000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker