Provider Demographics
NPI:1790176097
Name:LEE DEGNER, AMANDA JOSEPHINE (EDD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:JOSEPHINE
Last Name:LEE DEGNER
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 SARAH CT
Mailing Address - Street 2:
Mailing Address - City:RINEYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40162-8602
Mailing Address - Country:US
Mailing Address - Phone:229-343-1822
Mailing Address - Fax:
Practice Address - Street 1:125 SARAH CT
Practice Address - Street 2:
Practice Address - City:RINEYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40162-8602
Practice Address - Country:US
Practice Address - Phone:229-343-1822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-09
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007588101YP2500X
KY169075101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional