MEDICARE: MS. AMY LINDGREN

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
1	103K00000X	Behavior Analyst	B-10209521	OR

General Provider Information

NPI Number	:	1164815122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMY LINDGREN

Provider Business Mailing Address
First Line	:	2368 CRATER LAKE AVE STE 102
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97504-5006
Country	:	US
Telephone Number	:	541-727-1592
Fax Number	:

Provider Business Practice Location Address
First Line	:	2368 CRATER LAKE AVE STE 102
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97504-5006
Country	:	US
Telephone Number	:	541-727-1592
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2015
Last Update Date	:	09/17/2020

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