AMANDA PAULETTE GANNON (NPI# 1285234419) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285234419 |
| Entity Type | Individual |
| Full Name | AMANDA PAULETTE GANNON |
| Credential | CDC-I |
| Practice Address |
201 Deermount St Fl 2 Ketchikan AK 99901-6649 |
| Mailing Address |
Po Box 519 Ward Cove AK 99928-0519 |
| Practice Telephone | 9072289203 |
| Practice Fax Number | 8005903277 |
| Mailing Telephone | 5124238240 |
| Enumeration Date | 2020-10-27 |
| Last Update Date | 2020-10-27 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
4580 | AK | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | 1366719759 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366719759 | Amanda Marie Gannon | Occupational Therapist | 597 3rd Ave, Troy, NY 12182-2509 | 2011-11-29 |
| Street Address |
201 DEERMOUNT ST FL 2 |
| City | KETCHIKAN |
| State | AK |
| Zip Code | 99901-6649 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992314215 | Residential Youth Care, Inc. | Community/Behavioral Health | 2442 Tongass Avenue, Ketchikan, AK 99901 | 2020-07-23 |
| 1316563026 | Residential Youth Care, Inc. | Community/Behavioral Health | 606 Hill Road, Ketchikan, AK 99901 | 2020-06-18 |
| 1043836851 | Residential Youth Care, Inc. | Community/Behavioral Health | 2514 1st Avenue, Ketchikan, AK 99901 | 2020-06-18 |
| 1215553029 | Residential Youth Care, Inc. | Community/Behavioral Health | 2951 Baranof Avenue, Ketchikan, AK 99901 | 2020-06-18 |
| 1174159222 | Helene Rae Simpson | Behavior Technician | 201 Deermont St, Ketchikan, AK 99901 | 2020-03-20 |
| 1003295155 | Suzanne Webb | Massage Therapist | 602 Dock St Ste 106, Ketchikan, AK 99901 | 2015-05-22 |
| 1093194342 | Kate Mortensen | Case Manager/Care Coordinator | 2690 Tongass Ave, Ketchikan, AK 99901 | 2015-05-20 |
| 1578879631 | Thomas Peter Ryan | Social Worker | 320 Bawden St. #318, Ketchikan, AK 99901 | 2010-08-27 |
| 1689820979 | Akeela Inc | Community Based Residential Treatment Facility, Mental Illness | 3050 Fifth Ave, Ketchikan, AK 99901 | 2008-08-18 |
| 1750565438 | Susan Marie Swift | Nurse Practitioner | 21 Jefferson Way, Suite 202, Psychiatry, Ketchikan, AK 99901 | 2007-12-18 |
| Find all providers in zip 99901 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962020909 | Kenneth Hook | Counselor | 3050 Fifth Ave, Ketchikan, AK 99901-5773 | 2020-07-07 |
| 1235757287 | Estelle Cowie | Counselor | 3050 Fifth Ave, Ketchikan, AK 99901-5773 | 2020-07-07 |
| 1144848193 | Lance Ho | Counselor | 3050 Fifth Ave, Ketchikan, AK 99901-5773 | 2020-07-07 |
| 1659901767 | Debra Kinerk | Counselor | 201 Deermount St, Ketchikan, AK 99901-6649 | 2020-01-17 |
| 1790315893 | Jessica Breanne Lutton | Counselor | 201 Deermount St, Ketchikan, AK 99901-6649 | 2020-01-17 |
| 1669002770 | Darryl Anthony Simons | Counselor | 201 Deermount St, Ketchikan, AK 99901-6649 | 2020-01-17 |
| 1447880547 | Christine Marie Furey | Counselor | 201 Deermount St, Ketchikan, AK 99901-6649 | 2020-01-17 |
| 1306480611 | Laura Davidson | Counselor | 3050 Fifth Ave, Ketchikan, AK 99901-5773 | 2019-10-30 |
| 1851945422 | Melissa Fackler | Counselor | 3050 Fifth Ave, Ketchikan, AK 99901-5773 | 2019-07-31 |
| 1841844412 | Lonna Gabbard | Counselor | 3050 Fifth Ave, Ketchikan, AK 99901-5773 | 2019-07-31 |
| Find all providers in KETCHIKAN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.