Individual
MARK RICHARD AMUNDSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMIN
Contact information
Practice address
5650 N GREENBAY AVE, GLENDALE, WI 53209
(262) 789-1191
Mailing address
5650 N GREENBAY AVE, GLENDALE, WI 53209
(262) 789-1191
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
4127-125
WI
106H00000X
Marriage & Family Therapist
LH00009180
WA
Other
Enumeration date
10/02/2006
Last updated
07/14/2022
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