Provider Demographics
NPI:1447425699
Name:PFUNDER, AMY LEANN (MSW, LICSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LEANN
Last Name:PFUNDER
Suffix:
Gender:F
Credentials:MSW, LICSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17070 SE PINE CONE LN
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-5609
Mailing Address - Country:US
Mailing Address - Phone:503-806-7781
Mailing Address - Fax:
Practice Address - Street 1:17070 SE PINE CONE LN
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-5609
Practice Address - Country:US
Practice Address - Phone:503-806-7781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL35001041C0700X
WALW000075791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical