Provider Demographics
NPI:1831594274
Name:AMICUCCI, AMANDA JOAN (CPC)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JOAN
Last Name:AMICUCCI
Suffix:
Gender:F
Credentials:CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 165TH AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:LAKE TAPPS
Mailing Address - State:WA
Mailing Address - Zip Code:98391-4928
Mailing Address - Country:US
Mailing Address - Phone:206-643-0283
Mailing Address - Fax:
Practice Address - Street 1:221 WELLS AVE S
Practice Address - Street 2:SUITE 100
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2161
Practice Address - Country:US
Practice Address - Phone:425-528-2008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist