Healthcare Provider Details

I. General information

NPI: 1144718321
Provider Name (Legal Business Name): AMANDA BATES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17321 TELEGRAPH RD
DETROIT MI
48219-3132
US

IV. Provider business mailing address

4440 HUNT CLUB DR APT 2A
YPSILANTI MI
48197-9225
US

V. Phone/Fax

Practice location:
  • Phone: 313-531-2500
  • Fax:
Mailing address:
  • Phone: 313-658-3502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6801122046
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801122046
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: