Provider Demographics
NPI:1053177709
Name:KYSER, AMY PATRICIA (INTERN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:PATRICIA
Last Name:KYSER
Suffix:
Gender:F
Credentials:INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19289 GENTRY HIGHLANDS LN
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-7578
Mailing Address - Country:US
Mailing Address - Phone:503-501-8928
Mailing Address - Fax:
Practice Address - Street 1:9900 SW GREENBURG RD STE 235
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-5473
Practice Address - Country:US
Practice Address - Phone:503-410-3078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional