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General NPI Number Information
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NPI Number | 1992159024
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Entity Type | Individual
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Provider Name | AMANDA ELISABETH-JANE MALUCHNIK LMSW
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Gender | Female
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Dates
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Enumeration Date | 04/14/2016
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 375 APPLE TREE DR
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City | IONIA
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State | MI
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Zip | 48846-7506
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Country | US
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Telephone | 616-902-0229
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Fax |
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Provider Business Mailing Address
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Address Line | 960 ALPINE CHURCH RD NW APT C
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City | COMSTOCK PARK
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State | MI
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Zip | 49321-7303
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Country | US
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Telephone | 616-401-8267
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801114356
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License Number State | MI
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