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General NPI Number Information
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NPI Number | 1770197790
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Entity Type | Individual
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Provider Name | AMANDA BRUNETTE
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Gender | Female
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Dates
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Enumeration Date | 09/08/2020
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Last Update Date | 09/08/2020
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Provider Practice Location Address
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Address Line | 4330 SHAWNEE MISSION PKWY STE 2180
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City | FAIRWAY
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State | KS
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Zip | 66205-2522
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Country | US
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Telephone | 913-588-6973
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Fax |
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Provider Business Mailing Address
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Address Line | 6201 JOHNSON DR APT 506
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City | MISSION
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State | KS
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Zip | 66202-3483
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Country | US
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Telephone | 630-301-8901
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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 | 02892
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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