Provider Demographics
NPI:1841574969
Name:ELLIOTT, AMANDA ELIZABETH (LMSW, QIDP, CADC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:ELIZABETH
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LMSW, QIDP, CADC
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:ELIZABETH
Other - Last Name:GRAUBNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLBSW, CADC
Mailing Address - Street 1:500 HANCOCK STREET
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4224
Mailing Address - Country:US
Mailing Address - Phone:989-797-3400
Mailing Address - Fax:989-799-0206
Practice Address - Street 1:500 HANCOCK STREET
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-4224
Practice Address - Country:US
Practice Address - Phone:989-797-3400
Practice Address - Fax:989-799-0206
Is Sole Proprietor?:No
Enumeration Date:2011-10-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801096165104100000X, 1041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker