Doctor Name: | AMANDA DIMMEN-KLENK |
NPI Number: | 1831503036 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S. |
License Number: | |
Business Practice Address: | 88267 N Territorial Hwy Veneta, OR - 974879499 |
Business Phone Number: | 5417314471 |
Business Fax Number: | |
Mailing Address: | 20 E 13th Ave, EUGENE |
State: | OR |
Postal Code: | 974013535 |
Phone Number: | 5414844428 |
Fax Number: | |
NPI Enumeration Date: | 06/16/2014 |
NPI Last Update Date: | 06/16/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |