Individual
AMY A WADDELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
2149 JOLLY RD STE 500, OKEMOS, MI 48864-6028
(517) 347-4645
(517) 347-4644
Mailing address
13401 NORWAY PINE DR, DEWITT, MI 48820-9696
(517) 347-4645
(517) 347-4644
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6801073623
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6801073623
STATE OF MICHIGAN
MI
Enumeration date
10/26/2021
Last updated
10/26/2021
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