Provider Demographics
NPI:1841562048
Name:LOCKIE, AMANDA L
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:L
Last Name:LOCKIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:96117-0175
Mailing Address - Country:US
Mailing Address - Phone:530-310-4882
Mailing Address - Fax:
Practice Address - Street 1:105 E SYDNOR AVE STE 100
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-5546
Practice Address - Country:US
Practice Address - Phone:760-446-6404
Practice Address - Fax:760-446-6415
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner