Provider Demographics
NPI:1780837104
Name:ANDERSON-MOONEY, AMELIA JANE (PHD)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:JANE
Last Name:ANDERSON-MOONEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1759
Mailing Address - Country:US
Mailing Address - Phone:270-782-7800
Mailing Address - Fax:270-843-0779
Practice Address - Street 1:165 NATCHEZ TRACE AVE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-7940
Practice Address - Country:US
Practice Address - Phone:270-782-7800
Practice Address - Fax:270-843-0779
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2012-50103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist