Provider Demographics
NPI:1104645316
Name:UNGER, AMY SUE (PSYS)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:SUE
Last Name:UNGER
Suffix:
Gender:U
Credentials:PSYS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ADMINISTRATION DR
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-4846
Mailing Address - Country:US
Mailing Address - Phone:574-371-5098
Mailing Address - Fax:
Practice Address - Street 1:1 ADMINISTRATION DR
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-4846
Practice Address - Country:US
Practice Address - Phone:574-371-5098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10317067103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool