Provider Demographics
NPI:1285460295
Name:AMUNDSEN, MARIAN (PSYD)
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:AMUNDSEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 N CUSTER ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-3738
Mailing Address - Country:US
Mailing Address - Phone:662-210-4283
Mailing Address - Fax:
Practice Address - Street 1:727 N CUSTER ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-3738
Practice Address - Country:US
Practice Address - Phone:662-210-4283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist