Individual
AMANDA M SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1840 W HOUGHTON LAKE DR, PRUDENVILLE, MI 48651-9672
(989) 422-0279
Mailing address
1840 W HOUGHTON LAKE DR, PRUDENVILLE, MI 48651-9672
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
12/12/2017
Last updated
12/12/2017
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