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General NPI Number Information
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NPI Number | 1336499011
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Entity Type | Individual
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Provider Name | AMY ELIZABETH NAUGLE PH.D.
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Gender | Female
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Dates
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Enumeration Date | 09/11/2012
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Last Update Date | 09/11/2012
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Provider Practice Location Address
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Address Line | 9616 PORTAGE RD
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City | PORTAGE
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State | MI
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Zip | 49002-7257
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Country | US
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Telephone | 269-250-8200
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Fax |
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Provider Business Mailing Address
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Address Line | 2925 DUCHESS DR
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City | KALAMAZOO
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State | MI
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Zip | 49008-2315
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Country | US
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Telephone | 269-720-6715
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301011517
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License Number State | MI
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