Individual
AMY JO LILLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1070 W HOUGHTON LAKE DR, PRUDENVILLE, MI 48651-9613
(989) 202-4900
Mailing address
260 N CORNING ST APT 5, FARWELL, MI 48622-8724
(989) 202-4900
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
MI
Other
Enumeration date
05/19/2026
Last updated
05/19/2026
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