Healthcare Provider Details

I. General information

NPI: 1598358632
Provider Name (Legal Business Name): AMANDA KAY ESPINOZA MS, LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 TOWNER ST
YPSILANTI MI
48198-5723
US

IV. Provider business mailing address

555 TOWNER ST
YPSILANTI MI
48198-5723
US

V. Phone/Fax

Practice location:
  • Phone: 734-544-3050
  • Fax: 734-544-6732
Mailing address:
  • Phone: 734-544-3050
  • Fax: 734-544-6732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6361007759
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: