Provider Demographics
NPI:1548748619
Name:PULIDO, AMBER (IADC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:PULIDO
Suffix:
Gender:F
Credentials:IADC
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:FOLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:250 20TH AVE N STE 250
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-2506
Mailing Address - Country:US
Mailing Address - Phone:563-243-2124
Mailing Address - Fax:563-243-2190
Practice Address - Street 1:250 20TH AVE N STE 250
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-2506
Practice Address - Country:US
Practice Address - Phone:563-243-2124
Practice Address - Fax:563-243-2190
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAT18026101YA0400X
IA18064101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)