Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
N | 103G00000X | Clinical Psychologist | 071008473 | IL |
N | 103TC0700X | Clinical Psychologist | 071008473 | IL |
Y | 103G00000X | Clinical Psychologist | 2685 | OR |
Y | 103TC0700X | Clinical Psychologist | 2685 | OR |
NPI | 1003116112 |
---|---|
Provider Name | Dr. Amanda D Ball |
First Address | Portland, OR 97233-5757 |
Second Address | Portland, OR 97233-5757 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2010 |
Last Update Date | 28/12/2021 |