Provider Demographics
NPI:1518413525
Name:COHOON, AMANDA JESSICA (BSW)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:JESSICA
Last Name:COHOON
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2464 MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:KAWKAWLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48631-9759
Mailing Address - Country:US
Mailing Address - Phone:989-327-5092
Mailing Address - Fax:
Practice Address - Street 1:2464 MAPLE DR
Practice Address - Street 2:
Practice Address - City:KAWKAWLIN
Practice Address - State:MI
Practice Address - Zip Code:48631-9759
Practice Address - Country:US
Practice Address - Phone:989-327-5092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIXYQ925048755OtherBLUE CROSS BLUE SHIELD OF MICHIGAN