Provider Demographics
NPI:1023188216
Name:LUNDGREN, AMY (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:LUNDGREN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3512 NE 113TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-5738
Mailing Address - Country:US
Mailing Address - Phone:206-818-8152
Mailing Address - Fax:206-364-0731
Practice Address - Street 1:3512 NE 113TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-5738
Practice Address - Country:US
Practice Address - Phone:206-818-8152
Practice Address - Fax:206-364-0731
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003716103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical