Provider Demographics
NPI:1275916876
Name:GRIEWAHN, AMANDA (HIS)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:
Last Name:GRIEWAHN
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 HILL DR
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-9255
Mailing Address - Country:US
Mailing Address - Phone:517-392-7878
Mailing Address - Fax:734-222-1844
Practice Address - Street 1:777 KIMOLE LN STE 120
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1400
Practice Address - Country:US
Practice Address - Phone:517-264-0711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501004885237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist