MEDICARE: AMANDA STIENSTRA LMSW LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1083336424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMANDA STIENSTRA LMSW LLC

Provider Business Mailing Address
First Line	:	7210 COCONUT DR
Second Line	:
City	:	JENISON
State	:	MI
Zip	:	49428-8722
Country	:	US
Telephone Number	:	616-885-2676
Fax Number	:

Provider Business Practice Location Address
First Line	:	2874 PORT SHELDON ST STE E
Second Line	:
City	:	HUDSONVILLE
State	:	MI
Zip	:	49426-7898
Country	:	US
Telephone Number	:	616-379-9845
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL SOCIAL WORKER
Name	:	MRS. AMANDA M STIENSTRA
Credential	:	LMSW
Telephone Number	:	616-885-2676

Provider Enumeration Date	:	09/13/2022
Last Update Date	:	09/13/2022

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