Basic Information
| Provider Information | |||||||||
| NPI: | 1629626551 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHAFER | ||||||||
| FirstName: | AMELIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LLMSW | ||||||||
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| OtherLastName: | SCHON | ||||||||
| OtherFirstName: | AMELIA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 220 LEASIA ST | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488951422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5176040291 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1701 LAKE LANSING RD | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489123798 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8104947180 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2019 | ||||||||
| LastUpdateDate: | 09/04/2019 | ||||||||
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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 | 6801104862 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.