Provider Demographics
NPI:1982226882
Name:BARTLEY, AMANDA LINN (RDN, CD)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LINN
Last Name:BARTLEY
Suffix:
Gender:F
Credentials:RDN, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25723 SE 30TH ST
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-9176
Mailing Address - Country:US
Mailing Address - Phone:408-596-0110
Mailing Address - Fax:
Practice Address - Street 1:1700 WESTLAKE AVE N STE 700
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-3097
Practice Address - Country:US
Practice Address - Phone:408-596-0110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60949565133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered