Provider Demographics
NPI:1962453472
Name:AMLIE LEFOND, CATHERINE M (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:M
Last Name:AMLIE LEFOND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SEATTLE CHILDREN'S HOSPITAL
Mailing Address - Street 2:4800 SAND POINT WAY NE
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105
Mailing Address - Country:US
Mailing Address - Phone:206-987-2078
Mailing Address - Fax:
Practice Address - Street 1:SEATTLE CHILDREN'S HOSPITAL
Practice Address - Street 2:4800 SAND POINT WAY NE
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105
Practice Address - Country:US
Practice Address - Phone:206-987-2078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI468222084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34524800Medicaid
000017792NOtherHUMANA
F55212Medicare UPIN
0048Q73601Medicare ID - Type Unspecified