Provider Demographics
NPI:1750966198
Name:MCGREGOR, AMANDA KAITLIN (HAS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAITLIN
Last Name:MCGREGOR
Suffix:
Gender:F
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5344 PLAINFIELD AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-1009
Mailing Address - Country:US
Mailing Address - Phone:616-365-1979
Mailing Address - Fax:616-365-1964
Practice Address - Street 1:5344 PLAINFIELD AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-1009
Practice Address - Country:US
Practice Address - Phone:616-365-1979
Practice Address - Fax:616-365-1964
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501011799237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist