Healthcare Provider Details

I. General information

NPI: 1760302418
Provider Name (Legal Business Name): AMANDA RICKETTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1385 MAHAFFY AVE
ROCHESTER HILLS MI
48307-1507
US

IV. Provider business mailing address

4013 OAK TREE CIR
ROCHESTER MI
48306-4657
US

V. Phone/Fax

Practice location:
  • Phone: 248-726-4300
  • Fax:
Mailing address:
  • Phone: 734-358-0278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801086726
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: