Provider Demographics
NPI:1689009979
Name:SIMPSON, AMY SUSAN (LMSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:SUSAN
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:SUSAN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 776982
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6982
Mailing Address - Country:US
Mailing Address - Phone:231-672-2119
Mailing Address - Fax:
Practice Address - Street 1:905 E COLBY ST STE 100
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:MI
Practice Address - Zip Code:49461-1262
Practice Address - Country:US
Practice Address - Phone:231-672-8050
Practice Address - Fax:231-672-8048
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-05
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010859321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1689009979Medicaid