Provider Demographics
NPI:1356058648
Name:LUDTKE, AMANDA LEIGH
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEIGH
Last Name:LUDTKE
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 1:1425 BROADWAY # 273
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-3854
Mailing Address - Country:US
Mailing Address - Phone:832-312-3868
Mailing Address - Fax:
Practice Address - Street 1:19401 40TH AVE W STE 100
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5600
Practice Address - Country:US
Practice Address - Phone:832-312-3868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
106S00000XOtherBEHAVIOR TECHNICIAN