Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3856 | WI |
Y | 103T00000X | Psychologist | 3856 | WI |
N | 103TH0004X | Health Psychologist | 61018787 | WA |
NPI | 1619590726 |
---|---|
Provider Name | Dr. Amanda S. Phillips |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53718-2002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2020 |
Last Update Date | 20/01/2021 |