Provider Demographics
NPI:1194398255
Name:SMELKER, AMANDA ALICE (MSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ALICE
Last Name:SMELKER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:ALICE
Other - Last Name:LATIMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:BMH 39
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-341-6417
Mailing Address - Fax:269-341-8294
Practice Address - Street 1:8088 VINEYARD PKWY
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-3892
Practice Address - Country:US
Practice Address - Phone:269-286-7090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011099711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical