Provider Demographics
NPI:1497425151
Name:CONGDON, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:CONGDON
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 1:312 SW GREENWICH DR STE 618
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4408
Mailing Address - Country:US
Mailing Address - Phone:503-341-8746
Mailing Address - Fax:
Practice Address - Street 1:1239 NE DOUGLAS
Practice Address - Street 2:STE. C
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086
Practice Address - Country:US
Practice Address - Phone:816-200-1434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03799101YM0800X
MO2020040586101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health