Provider Demographics
NPI:1013084300
Name:FRIDAY, AMY SUSAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:SUSAN
Last Name:FRIDAY
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 1:14780 SW OSPREY DR. #285
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007
Mailing Address - Country:US
Mailing Address - Phone:503-308-4251
Mailing Address - Fax:503-591-8628
Practice Address - Street 1:14780 SW OSPREY DR.
Practice Address - Street 2:#285
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007
Practice Address - Country:US
Practice Address - Phone:503-308-4251
Practice Address - Fax:503-591-8628
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12246103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR157888Medicare PIN