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General NPI Number Information
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NPI Number | 1770713778
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Entity Type | Individual
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Provider Name | AMY B WILLCOXON PSYD
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Gender | Female
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Dates
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Enumeration Date | 07/24/2009
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Last Update Date | 12/09/2019
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Provider Practice Location Address
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Address Line | 1077 WHITEFISH STAGE
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City | KALISPELL
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State | MT
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Zip | 59901-2735
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Country | US
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Telephone | 406-249-0824
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Fax | 406-890-6817
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Provider Business Mailing Address
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Address Line | 320 4TH AVE W
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City | KALISPELL
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State | MT
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Zip | 59901-4816
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Country | US
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Telephone | 406-407-6914
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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 | 4031
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1478
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License Number State | MT
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