Provider Demographics
NPI:1689551624
Name:GOW, AMANDA (REGISTERED ASSOCIATE)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:GOW
Suffix:
Gender:F
Credentials:REGISTERED ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61182 HUBBLE ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3063
Mailing Address - Country:US
Mailing Address - Phone:541-610-5826
Mailing Address - Fax:
Practice Address - Street 1:760 NW HARRIMAN ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2789
Practice Address - Country:US
Practice Address - Phone:541-316-0266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR11768101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional