| Doctor Name: | MS. AMY JEANNE GUDERJOHN |
| NPI Number: | 1548562689 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 403 N Clarence Nash Blvd Watonga, OK - 737723636 |
| Business Phone Number: | 5806235433 |
| Business Fax Number: | |
| Mailing Address: | 2120 E Highway 66, EL RENO |
| State: | OK |
| Postal Code: | 730366623 |
| Phone Number: | 3167652134 |
| Fax Number: | |
| NPI Enumeration Date: | 11/22/2010 |
| NPI Last Update Date: | 11/22/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |