Provider Demographics
NPI:1669822573
Name:RAY, AMANDA NICOLE (MSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:NICOLE
Last Name:RAY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 SE STRATUS AVE UNIT 301
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-6257
Mailing Address - Country:US
Mailing Address - Phone:503-474-1148
Mailing Address - Fax:503-434-6148
Practice Address - Street 1:2700 SE STRATUS AVE UNIT 301
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-6257
Practice Address - Country:US
Practice Address - Phone:503-474-1148
Practice Address - Fax:503-434-6148
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker