Healthcare Provider Details

I. General information

NPI: 1750148805
Provider Name (Legal Business Name): ANDREA NICOLE SAMMONS MSW LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA NICOLE BLEVINS

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4633 AICHOLTZ RD
CINCINNATI OH
45244-1447
US

IV. Provider business mailing address

4628 AICHOLTZ RD
CINCINNATI OH
45244-1446
US

V. Phone/Fax

Practice location:
  • Phone: 513-752-1555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2308768
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: