Provider Demographics
NPI:1558423434
Name:MELICK, AMY MARIE (PHD)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MARIE
Last Name:MELICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:MARIE
Other - Last Name:WALTHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6010 86TH AVENUE SE
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040
Mailing Address - Country:US
Mailing Address - Phone:206-275-4572
Mailing Address - Fax:
Practice Address - Street 1:17220 127TH PLACE NE
Practice Address - Street 2:#300
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072
Practice Address - Country:US
Practice Address - Phone:425-985-5236
Practice Address - Fax:360-387-7734
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003531103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA2427OtherBCBS