Provider Demographics
NPI:1306058441
Name:PLAVNICK, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:PLAVNICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 W LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6560
Mailing Address - Country:US
Mailing Address - Phone:734-368-9691
Mailing Address - Fax:833-633-6171
Practice Address - Street 1:2610 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-6560
Practice Address - Country:US
Practice Address - Phone:734-368-9691
Practice Address - Fax:833-633-6171
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801089059104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker