Provider Demographics
NPI:1922819572
Name:HENDRICKS, AMY LYNNETTE
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNNETTE
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 W CANFIELD AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-7953
Mailing Address - Country:US
Mailing Address - Phone:208-290-8207
Mailing Address - Fax:
Practice Address - Street 1:560 W CANFIELD AVE STE 300
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-7953
Practice Address - Country:US
Practice Address - Phone:208-290-8207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID6471645101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health