Provider Demographics
NPI:1801307426
Name:GRECO-ODOR, AMANDA EILEEN
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:EILEEN
Last Name:GRECO-ODOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:EILEEN
Other - Last Name:GRECO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2408 N COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-9123
Mailing Address - Country:US
Mailing Address - Phone:503-313-5411
Mailing Address - Fax:
Practice Address - Street 1:113 N ELM ST
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-3519
Practice Address - Country:US
Practice Address - Phone:503-263-8903
Practice Address - Fax:503-266-8632
Is Sole Proprietor?:No
Enumeration Date:2017-10-23
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist