Individual
DR. AMY H PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
9040 JACKSON AVE, TACOMA, WA 98431-2871
(360) 810-1659
Mailing address
9040 JACKSON AVE, TACOMA, WA 98431-0001
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
048-0000851
VT
103TC0700X
Clinical Psychologist
Primary
PY00003942
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1010917
—
VT
01
—
2207559
CIGNA
VT
01
—
356373
MHN
VT
01
—
540506
VALUE OPTIONS
VT
01
—
68315
BCBS
VT
05
—
8524290
—
WA
Enumeration date
02/21/2006
Last updated
09/16/2019
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