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NPI Code Detail

MEDICARE: AMY B WILLCOXON PSYD

MEDICARE: AMY B WILLCOXON PSYD
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
1103TC0700XClinical Psychologist4031AZ
2103TC0700XClinical Psychologist1478MT

General Provider Information

NPI Number : 1770713778
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY B WILLCOXON PSYD
Provider Business Mailing Address
First Line : 320 4TH AVE W
Second Line :
City : KALISPELL
State : MT
Zip : 59901-4816
Country : US
Telephone Number : 406-407-6914
Fax Number :
Provider Business Practice Location Address
First Line : 1077 WHITEFISH STAGE
Second Line :
City : KALISPELL
State : MT
Zip : 59901-2735
Country : US
Telephone Number : 406-249-0824
Fax Number : 406-890-6817
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2009
Last Update Date : 12/09/2019

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