Provider Demographics
NPI:1376678409
Name:RUDISILL, AMY J (MHS)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:RUDISILL
Suffix:
Gender:F
Credentials:MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 BROOKSIDE RD STE 80
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106-9023
Mailing Address - Country:US
Mailing Address - Phone:484-867-7078
Mailing Address - Fax:
Practice Address - Street 1:1005 BROOKSIDE RD STE 80
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9023
Practice Address - Country:US
Practice Address - Phone:484-867-7078
Practice Address - Fax:833-381-0909
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PAPC004900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health