Healthcare Provider Details

I. General information

NPI: 1790693133
Provider Name (Legal Business Name): AMANDA WELLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6220 BELMONT AVE NE UNIT 26
BELMONT MI
49306-1112
US

IV. Provider business mailing address

PO BOX 26
BELMONT MI
49306-0026
US

V. Phone/Fax

Practice location:
  • Phone: 616-327-2405
  • Fax: 616-259-4214
Mailing address:
  • Phone: 616-327-2405
  • Fax: 616-259-4214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: