Provider Demographics
NPI:1457670820
Name:WEATHERBY, AMANDA V (PHD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:V
Last Name:WEATHERBY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E EVERGREEN BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-3264
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:360-844-6068
Practice Address - Street 1:400 E EVERGREEN BLVD STE 210
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3264
Practice Address - Country:US
Practice Address - Phone:626-676-3927
Practice Address - Fax:360-844-6068
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00003931103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist