Healthcare Provider Details

I. General information

NPI: 1629303466
Provider Name (Legal Business Name): AMY ELIZABETH SMITH LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2009
Last Update Date: 10/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 E CHART ST
PLAINWELL MI
49080-1768
US

IV. Provider business mailing address

2307 BENTON AVE
KALAMAZOO MI
49008-2730
US

V. Phone/Fax

Practice location:
  • Phone: 269-685-6363
  • Fax: 269-685-5995
Mailing address:
  • Phone: 269-492-9184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801085380
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: