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NPI Code Detail

MEDICARE: AMANDA LYNN CISSE MSW

MEDICARE: AMANDA LYNN CISSE MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker6801091799MI

General Provider Information

NPI Number : 1306186812
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA LYNN CISSE MSW
Provider Business Mailing Address
First Line : 9249 W LAKE CITY RD
Second Line :
City : HOUGHTON LAKE
State : MI
Zip : 48629-9602
Country : US
Telephone Number : 989-422-5122
Fax Number :
Provider Business Practice Location Address
First Line : 439 S ROSS ST
Second Line :
City : BEAVERTON
State : MI
Zip : 48612-9101
Country : US
Telephone Number : 989-422-5122
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2013
Last Update Date : 03/17/2018

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Directions to “ AMANDA LYNN CISSE MSW” Practice Location

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