Basic Information
| Provider Information | |||||||||
| NPI: | 1558596270 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KINNER | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | DANIELLE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20608 FLEETWOOD DR | ||||||||
| Address2: | |||||||||
| City: | HARPER WOODS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482251626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3136409185 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 20811 KELLY RD | ||||||||
| Address2: | STE 103 | ||||||||
| City: | EASTPOINTE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480213139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5864452210 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2009 | ||||||||
| LastUpdateDate: | 05/26/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801067960 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.