Provider Demographics
NPI:1811640873
Name:WALKER, AMANDA BROOKE (CRM)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:BROOKE
Last Name:WALKER
Suffix:
Gender:F
Credentials:CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12215 BALLSTON RD
Mailing Address - Street 2:
Mailing Address - City:AMITY
Mailing Address - State:OR
Mailing Address - Zip Code:97101-9517
Mailing Address - Country:US
Mailing Address - Phone:971-312-3992
Mailing Address - Fax:
Practice Address - Street 1:627 NE EVANS ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-3923
Practice Address - Country:US
Practice Address - Phone:503-434-7527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 175T00000X
OR23-06-10792101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist