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NPI Code Detail

MEDICARE: AMY MARIE BISSINGER PSY.D.

MEDICARE: AMY MARIE BISSINGER PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist3569OR

General Provider Information

NPI Number : 1376271502
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY MARIE BISSINGER PSY.D.
Provider Business Mailing Address
First Line : 2853 W PICO DEL MONTE CIR
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86001-9203
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1050 SW 6TH AVE STE 1100
Second Line :
City : PORTLAND
State : OR
Zip : 97204-1153
Country : US
Telephone Number : 503-899-4247
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2022
Last Update Date : 08/19/2022

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