Provider Demographics
NPI:1639763410
Name:RANCOURT, AMIE LEANN
Entity Type:Individual
Prefix:MRS
First Name:AMIE
Middle Name:LEANN
Last Name:RANCOURT
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:AMIE
Other - Middle Name:LEANN
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:169 MASON ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4482
Mailing Address - Country:US
Mailing Address - Phone:707-463-3300
Mailing Address - Fax:
Practice Address - Street 1:169 MASON ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4482
Practice Address - Country:US
Practice Address - Phone:707-463-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker