Provider Demographics
NPI:1902048283
Name:MCGLYNN, AMY GORDON (PHD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:GORDON
Last Name:MCGLYNN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:3027 MILLER HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-1824
Mailing Address - Country:US
Mailing Address - Phone:503-739-2654
Mailing Address - Fax:
Practice Address - Street 1:3027 MILLER HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-1824
Practice Address - Country:US
Practice Address - Phone:503-739-2654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002742103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist