Healthcare Provider Details

I. General information

NPI: 1407304165
Provider Name (Legal Business Name): AMANDA LEINBERGER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 N STATE ST
STANTON MI
48888-9702
US

IV. Provider business mailing address

4604 N SAGINAW RD STE N-2
MIDLAND MI
48640-2387
US

V. Phone/Fax

Practice location:
  • Phone: 989-831-7520
  • Fax: 989-831-7578
Mailing address:
  • Phone: 989-282-1200
  • Fax: 989-282-1400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801100229
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: