Healthcare Provider Details

I. General information

NPI: 1710446091
Provider Name (Legal Business Name): AMY BETH VUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2019
Last Update Date: 03/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3361 36TH ST SE
KENTWOOD MI
49512-2809
US

IV. Provider business mailing address

3361 36TH ST SE
KENTWOOD MI
49512-2809
US

V. Phone/Fax

Practice location:
  • Phone: 616-248-5201
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: