Healthcare Provider Details

I. General information

NPI: 1174656052
Provider Name (Legal Business Name): AMY MICHELE DONNENWERTH MA, MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6957 N FIGUEROA ST
LOS ANGELES CA
90042-1245
US

IV. Provider business mailing address

2442 LOMA VISTA ST
PASADENA CA
91104-3403
US

V. Phone/Fax

Practice location:
  • Phone: 313-443-3160
  • Fax:
Mailing address:
  • Phone: 323-443-3160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number8514
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: