MEDICARE: WENDY SUE AMUNDSON MS, LPC

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	101YP2500X	Professional Counselor	003604	GA

General Provider Information

NPI Number	:	1790347557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY SUE AMUNDSON MS, LPC

Provider Business Mailing Address
First Line	:	200 STATE ST STE 302
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02109-2672
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3615 CHARLES HARDY PKWY
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30157-9472
Country	:	US
Telephone Number	:	844-375-7212
Fax Number	:

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

Provider Enumeration Date	:	07/02/2019
Last Update Date	:	07/02/2019

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