Individual ProviderAmanda KruszkaSocial WorkerBehavioral Health & Social Service ProvidersPractice Address17200 NW Corridor Ct Ste 110, Beaverton, OR 97006-3295(503) 656-9030(503) 941-3077PECOS EnrollmentBased on the most recent information from CMS, provider Amanda Kruszka does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1427508381Provider TypeIndividualFull NameKruszka, AmandaCredentialLCSWGenderFemaleSole ProprietorNoEnumeration Date10/4/2016Last Updated3/25/2020Contact InformationPractice LocationPractice Address17200 NW Corridor Ct Ste 110, Beaverton, OR 97006-3295Phone(503) 656-9030FaxUnlisted FaxMailing LocationMailing Address7320 SW Hunziker Rd Ste 300, Portland, OR 97223-2302Phone(503) 941-3077FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicenseL6628OregonProvider IdentifiersIDDescriptionIssuerID500715554DescriptionMedicaidIssuerUnlistedOregon