Healthcare Provider Details

I. General information

NPI: 1679943625
Provider Name (Legal Business Name): AMANDA SPRINGSTEEN BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2015
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26243 AUDREY AVE
WARREN MI
48091-1215
US

IV. Provider business mailing address

26243 AUDREY AVE
WARREN MI
48091-1215
US

V. Phone/Fax

Practice location:
  • Phone: 248-321-7617
  • Fax:
Mailing address:
  • Phone: 248-321-7617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801113948
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: