Active NPI
Amy Kathleen Pruneau, LLP
- Clinical Child & Adolescent Psychologist
- Walled Lake, MI
National Provider Identifier
1053603225
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 6301014003
- Practice address
- 260 Neptune Dr
Walled Lake, MI 48390-3661 - Phone
- (248) 821-6485
- NPI assigned
- May 6, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | 6301014003 | MI | Primary |
Addresses
Primary practice location
260 Neptune Dr
Walled Lake, MI 48390-3661
Mailing address
260 Neptune Dr
Walled Lake, MI 48390-3661
Phone (248) 821-6485
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301014003 | MI | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1304640000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1304640000000",
"number": "1053603225",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "260 NEPTUNE DR",
"city": "WALLED LAKE",
"state": "MI",
"postal_code": "483903661",
"telephone_number": "248-821-6485"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "260 NEPTUNE DR",
"city": "WALLED LAKE",
"state": "MI",
"postal_code": "483903661",
"telephone_number": "248-821-6485"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRUNEAU",
"first_name": "AMY",
"middle_name": "KATHLEEN",
"name_prefix": "Miss",
"credential": "LLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-05-06",
"last_updated": "2011-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "MI",
"license": "6301014003",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Walled Lake, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.