Provider Demographics
NPI:1629133996
Name:AMUNDSON, GARTH WILLIAM (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GARTH
Middle Name:WILLIAM
Last Name:AMUNDSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:608 14TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARKFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:56223-1239
Mailing Address - Country:US
Mailing Address - Phone:320-321-2842
Mailing Address - Fax:
Practice Address - Street 1:1125 6TH ST SE
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-4675
Practice Address - Country:US
Practice Address - Phone:320-235-4613
Practice Address - Fax:855-625-7406
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71005077103TC0700X
MNLP6307103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNLP6307OtherSTATE OF MINNESOTA BOARD OF PSYCHOLOGY