Healthcare Provider Details

I. General information

NPI: 1962984096
Provider Name (Legal Business Name): SAMANTHA STUNDON LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 W SOUTH BOUNDARY ST STE 550
PERRYSBURG OH
43551-5234
US

IV. Provider business mailing address

615 KINGSBURY ST
MAUMEE OH
43537-1865
US

V. Phone/Fax

Practice location:
  • Phone: 567-218-0185
  • Fax: 419-930-6721
Mailing address:
  • Phone: 567-218-0185
  • Fax: 419-930-6721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2607152
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1701712
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: