MEDICARE: AMANDA CLAIRE EBERBACH

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
1	104100000X	Social Worker	6801114889	MI
2	104100000X	Social Worker
3	1041C0700X	Clinical Social Worker	6801114889	MI
4	104100000X	Social Worker	6801102102	MI

General Provider Information

NPI Number	:	1346755642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA CLAIRE EBERBACH

Provider Business Mailing Address
First Line	:	214 W WACKERLY ST STE 200
Second Line	:
City	:	MIDLAND
State	:	MI
Zip	:	48640-2795
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	214 W WACKERLY ST STE 200
Second Line	:
City	:	MIDLAND
State	:	MI
Zip	:	48640-2795
Country	:	US
Telephone Number	:	989-272-3812
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2017
Last Update Date	:	10/01/2025

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Directions to “ AMANDA CLAIRE EBERBACH ” Practice Location

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