Healthcare Provider Details

I. General information

NPI: 1194315556
Provider Name (Legal Business Name): AMANDA PAIGE HEYMAN LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2021
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6548 TOWN CENTER DR STE D
CLARKSTON MI
48346-4823
US

IV. Provider business mailing address

6548 TOWN CENTER DR STE D
CLARKSTON MI
48346-4823
US

V. Phone/Fax

Practice location:
  • Phone: 248-469-8918
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851114273
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: