Provider Demographics
NPI:1164815122
Name:LINDGREN, AMY
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:LINDGREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2368 CRATER LAKE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5006
Mailing Address - Country:US
Mailing Address - Phone:541-727-1592
Mailing Address - Fax:
Practice Address - Street 1:2368 CRATER LAKE AVE STE 102
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-5006
Practice Address - Country:US
Practice Address - Phone:541-727-1592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-13
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORB-10209521103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst