Basic Information
| Provider Information | |||||||||
| NPI: | 1801307426 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRECO-ODOR | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | EILEEN | ||||||||
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| OtherLastName: | GRECO | ||||||||
| OtherFirstName: | AMANDA | ||||||||
| OtherMiddleName: | EILEEN | ||||||||
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| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2408 N COLLEGE ST | ||||||||
| Address2: | |||||||||
| City: | NEWBERG | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971329123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033135411 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 113 N ELM ST | ||||||||
| Address2: | |||||||||
| City: | CANBY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970133519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032638903 | ||||||||
| FaxNumber: | 5032668632 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2017 | ||||||||
| LastUpdateDate: | 02/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | OR | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.