Provider Demographics
NPI:1134831357
Name:ROSE, AMANDA MAE (MSSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MAE
Last Name:ROSE
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 N TIFFANY DR
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-8409
Mailing Address - Country:US
Mailing Address - Phone:206-225-6565
Mailing Address - Fax:
Practice Address - Street 1:3223 E PALMER WASILLA HWY STE 4
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7277
Practice Address - Country:US
Practice Address - Phone:907-631-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical