Provider Demographics
NPI:1780278929
Name:DAWNRICH, AMANDA DIANE (RSST)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:DIANE
Last Name:DAWNRICH
Suffix:
Gender:F
Credentials:RSST
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:DIANE
Other - Last Name:WILLIAMS, CURRIN, GRECH ,TRAWINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:313 MOROSS RD.
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48236
Mailing Address - Country:US
Mailing Address - Phone:313-487-4203
Mailing Address - Fax:734-467-7646
Practice Address - Street 1:313 MOROSS RD.
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE FARMS
Practice Address - State:MI
Practice Address - Zip Code:48236
Practice Address - Country:US
Practice Address - Phone:313-487-4203
Practice Address - Fax:734-467-7646
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI382849658Medicaid