Healthcare Provider Details

I. General information

NPI: 1821935651
Provider Name (Legal Business Name): AMANDA KING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8471 S WISNER AVE
NEWAYGO MI
49337-9606
US

IV. Provider business mailing address

8471 S WISNER AVE
NEWAYGO MI
49337-9606
US

V. Phone/Fax

Practice location:
  • Phone: 616-498-5936
  • Fax:
Mailing address:
  • Phone: 616-498-5936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: