Provider Demographics
NPI:1265974620
Name:EWING, AMANDA RENAE KRISTIAN (LICSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:RENAE KRISTIAN
Last Name:EWING
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15325 N NEWPORT HWY
Mailing Address - Street 2:
Mailing Address - City:MEAD
Mailing Address - State:WA
Mailing Address - Zip Code:99021-9592
Mailing Address - Country:US
Mailing Address - Phone:360-513-0550
Mailing Address - Fax:
Practice Address - Street 1:15325 N NEWPORT HWY
Practice Address - Street 2:
Practice Address - City:MEAD
Practice Address - State:WA
Practice Address - Zip Code:99021-9592
Practice Address - Country:US
Practice Address - Phone:360-513-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA610890471041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical