Provider Demographics
NPI:1689709511
Name:AMUNDSON, LINDA M (MFT, LMFT, LSW)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:M
Last Name:AMUNDSON
Suffix:
Gender:F
Credentials:MFT, LMFT, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:GRANTSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:54840-7821
Mailing Address - Country:US
Mailing Address - Phone:715-463-2651
Mailing Address - Fax:
Practice Address - Street 1:809 US HIGHWAY 8
Practice Address - Street 2:
Practice Address - City:ST. CROIX FALLS
Practice Address - State:WI
Practice Address - Zip Code:54024
Practice Address - Country:US
Practice Address - Phone:715-483-3544
Practice Address - Fax:715-483-3741
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI639-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist