Provider Demographics
NPI:1417363599
Name:SLENKER, AMY L (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:L
Last Name:SLENKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:MC A410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2626 N 3RD ST FL 2
Practice Address - Street 2:PENN STATE HERSHEY TLC CLINIC
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-2044
Practice Address - Country:US
Practice Address - Phone:717-531-4100
Practice Address - Fax:717-531-0770
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW130647104100000X
PACW0192801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA547178OtherMEDICARE PTAN