Provider Demographics
NPI:1164615902
Name:KNUDSEN, AMBER PATRICIA (BA)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:PATRICIA
Last Name:KNUDSEN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 NW 39TH ST. SUITE 101
Mailing Address - Street 2:
Mailing Address - City:LINCOLN CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97367
Mailing Address - Country:US
Mailing Address - Phone:541-994-2905
Mailing Address - Fax:541-994-3824
Practice Address - Street 1:2015 NW 39TH ST STE 101
Practice Address - Street 2:
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367-4822
Practice Address - Country:US
Practice Address - Phone:541-994-2905
Practice Address - Fax:541-994-3824
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor