Individual
AMANDA LYNN BOLOTTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
400 STODDARD RD, RICHMOND, MI 48062-2505
(810) 392-2167
Mailing address
1614 MCPHERSON ST, PORT HURON, MI 48060-3239
(810) 941-2711
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
10/07/2019
Last updated
11/27/2023
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