Healthcare Provider Details

I. General information

NPI: 1962858084
Provider Name (Legal Business Name): INGRID AMMONDSON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2016
Last Update Date: 05/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 MANOR PLZ
PACIFICA CA
94044-1839
US

IV. Provider business mailing address

480 MANOR PLZ
PACIFICA CA
94044-1839
US

V. Phone/Fax

Practice location:
  • Phone: 605-355-8787
  • Fax: 650-355-8780
Mailing address:
  • Phone: 605-355-8787
  • Fax: 650-355-8780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY27792
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: