Individual
AMANDA SUSAN EVELETH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW, BCBA
Contact information
Practice address
375 APPLE TREE DR, IONIA, MI 48846
(616) 527-1790
(616) 527-0538
Mailing address
375 APPLE TREE DR, IONIA, MI 48846-7506
(616) 527-1790
(616) 527-0538
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
7401000217
MI
103K00000X
Behavior Analyst
—
—
104100000X
Social Worker
6801091244
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1715928
—
MI
Enumeration date
02/15/2008
Last updated
05/09/2024
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