Individual
MS. AMANDA JESSICA COHOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSW
Contact information
Practice address
2464 MAPLE DR, KAWKAWLIN, MI 48631-9759
(989) 327-5092
Mailing address
2464 MAPLE DR, KAWKAWLIN, MI 48631-9759
(989) 327-5092
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
XYQ925048755
BLUE CROSS BLUE SHIELD OF MICHIGAN
MI
Enumeration date
08/30/2016
Last updated
08/30/2016
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