Amanda Fowler, LSWAIC

Primary specialty

Social WorkerTaxonomy code 104100000X

License

SC61201957 Issued in WA

Practice address

2330 Eastgate St Ste 105
Walla Walla, WA 99362-1559

Phone

(509) 973-5788

NPI assigned

Sep 7, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Talk Heal Thrive Psychotherapy, PLLC

  • Mental Health Counselor
  • Seattle, WA
  • NPI 1154025831
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1630972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630972800000",
    "number": "1285303909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 E MAPLE ST",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993624203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2330 EASTGATE ST STE 105",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993621559",
            "telephone_number": "509-973-5788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOWLER",
        "first_name": "AMANDA",
        "credential": "LSWAIC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-09-07",
        "last_updated": "2021-09-07",
        "certification_date": "2021-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WA",
            "license": "SC61201957",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://www.bluemountainhealthcooperative.org/outpatient-clinic.html",
            "affiliation": "Y",
            "endpointDescription": "BMHC Outpatient Website",
            "affiliationName": "Blue Mountain Health Cooperative",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Contact for Blue Mountain Health Cooperative",
            "address_1": "2330 Eastgate St Ste 105",
            "city": "Walla Walla",
            "state": "WA",
            "country_code": "US",
            "postal_code": "993621559",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Elizabeth Follis
• Lawrence Stanley Forsberg
• Susan Forsberg, OT
• David Andrew Forsyth, RN 60468173
• Debbie Anne Forsyth, OTR/L
• Nathan D Franklin, M.A.
• Mary Elizabeth Freeman, R.D. C.D.E.
• Mark D Frewing, DPT
• Delia Sarah Frey, LSWAIC
• Sara Lynne Frey, LMP

• Social Worker in Walla Walla, WA
• Providers in Walla Walla, WA by specialty
• Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.