Provider Demographics
NPI:1619023827
Name:SANGDER, AMY LEE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LEE
Last Name:SANGDER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11901 55TH AVE NE
Mailing Address - Street 2:#2
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98271-8542
Mailing Address - Country:US
Mailing Address - Phone:360-653-9027
Mailing Address - Fax:
Practice Address - Street 1:3710 168TH ST NE
Practice Address - Street 2:SUITE #B201
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8416
Practice Address - Country:US
Practice Address - Phone:425-737-5812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021168174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist