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1780239145
AMANDA MARIE WALLEN
WASILLA, AK
NPI
1780239145
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2019-08-02
Last Update Date
2019-08-02
Business Address
AMANDA MARIE WALLEN
7010 E BOGARD RD
WASILLA, AK 99654-4711
Phone number: 907-373-4732
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Mailing Address
AMANDA MARIE WALLEN
PO BOX 876741
WASILLA, AK 99687-6741
Phone number: 907-373-4732
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