Provider Demographics
NPI:1073353637
Name:HAMILTON, AMANDA (AUD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 GEZON PKWY SW STE A
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49509-9564
Mailing Address - Country:US
Mailing Address - Phone:616-530-8883
Mailing Address - Fax:616-530-8997
Practice Address - Street 1:901 GEZON PKWY SW STE A
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49509-9564
Practice Address - Country:US
Practice Address - Phone:616-530-8883
Practice Address - Fax:616-530-8997
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601001153231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist