Provider Demographics
NPI:1740558378
Name:HENDRICKSON, AMANDA DOREEN
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:DOREEN
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:DOREEN
Other - Last Name:FREE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 LA PALOMA DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-1418
Mailing Address - Country:US
Mailing Address - Phone:865-525-0391
Mailing Address - Fax:865-525-0393
Practice Address - Street 1:4038 GAP RD
Practice Address - Street 2:SUITE 202
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37912-5903
Practice Address - Country:US
Practice Address - Phone:865-525-0391
Practice Address - Fax:865-525-0393
Is Sole Proprietor?:No
Enumeration Date:2011-12-10
Last Update Date:2011-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator