Individual
AMANDA LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8413 COTTONWOOD DR, JENISON, MI 49428-8327
(574) 208-2868
Mailing address
215 RED COACH DR, MISHAWAKA, IN 46545-8307
(574) 387-4313
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/23/2025
Last updated
07/23/2025
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