Provider Demographics
NPI:1649533068
Name:HERR, AMANDA LYN
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYN
Last Name:HERR
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 1:4327 PINE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-8960
Mailing Address - Country:US
Mailing Address - Phone:541-891-1005
Mailing Address - Fax:
Practice Address - Street 1:4327 PINE GROVE RD
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-8960
Practice Address - Country:US
Practice Address - Phone:541-891-1005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst