Provider Demographics
NPI:1790500718
Name:HAGEMANN-ARREDONDO, AMANDA JUSTINE
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JUSTINE
Last Name:HAGEMANN-ARREDONDO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:JUSTINE
Other - Last Name:ARREDONDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:812 COURT ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-3517
Mailing Address - Country:US
Mailing Address - Phone:530-662-2699
Mailing Address - Fax:
Practice Address - Street 1:285 4TH ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3501
Practice Address - Country:US
Practice Address - Phone:530-662-2699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-15
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CAR1548680224101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)