Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 622 | KS |
Y | 102L00000X | Psychologist | 339 | KS |
Y | 103T00000X | Psychologist | 339 | KS |
NPI | 1013017862 |
---|---|
Provider Name | Amanda Pfannenstiel |
First Address | Salina, KS 67401-2353 |
Second Address | Hays, KS 67601-1916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 14/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200439600B | (05) | KS |