NPI Code Detail JSON Logo

1457810871 NPI number — AMANDA BODE DAVIDSON MS LLP

NPI Number: 1457810871
Health Care Provider/Practitioner: AMANDA BODE DAVIDSON MS LLP

Information about “1457810871” NPI (AMANDA BODE DAVIDSON MS LLP) exists in 1457810871 in HTML format HTML  |  1457810871 in plain Text format TXT  |  1457810871 in PDF (Portable Document Format) PDF  |  1457810871 in an XML format XML  formats.

NPI Number : 1457810871 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1457810871",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DAVIDSON",
    "FirstName": "AMANDA",
    "MiddleName": "BODE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "MS LLP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BODE",
    "OtherFirstName": "AMANDA",
    "OtherMiddleName": "MARY",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": "MS LLP",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "29488 WOODWARD AVE # 361",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ROYAL OAK",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48073-0903",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "486-093-1832",
    "MailingAddressFaxNumber": "248-278-4934",
    "FirstLinePracticeLocationAddress": "29488 WOODWARD AVE # 361",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ROYAL OAK",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48073-0903",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "486-093-1832",
    "PracticeLocationAddressFaxNumber": "248-278-4934",
    "EnumerationDate": "03/15/2019",
    "LastUpdateDate": "03/26/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "103TC0700X",
          "TaxonomyName": "Clinical Psychologist",
          "LicenseNumber": "6361999795",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103T00000X",
          "TaxonomyName": "Psychologist",
          "LicenseNumber": "6301016482",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.