Individual
AMANDA STEVENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
23400 MICHIGAN AVE STE P40, DEARBORN, MI 48124-1928
(313) 689-5188
Mailing address
23400 MICHIGAN AVE STE P40, DEARBORN, MI 48124-1928
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
1690135748
MI
Other
Enumeration date
02/18/2017
Last updated
02/18/2017
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