Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 6301013840 | MI |
N | 103TC0700X | Clinical Psychologist | 6301013840 | MI |
Y | 103G00000X | Clinical Psychologist | 6301013840 | MI |
Y | 103TC0700X | Clinical Psychologist | 6301013840 | MI |
N | 103TR0400X | Rehabilitation Psychologist | 6301013840 | MI |
NPI | 1396987871 |
---|---|
Provider Name | Dr. Amanda Jean Schafer Johnson |
First Address | Belfast, ME 04915-4029 |
Second Address | Marquette, MI 49855-2736 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2009 |
Last Update Date | 25/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1396987871 | (05) | MI |