Healthcare Provider Details

I. General information

NPI: 1972929040
Provider Name (Legal Business Name): AMY GARDNER-WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2014
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3649 LEE RD
SHAKER HEIGHTS OH
44120-5108
US

IV. Provider business mailing address

18220 WINSLOW RD
SHAKER HEIGHTS OH
44122-4809
US

V. Phone/Fax

Practice location:
  • Phone: 216-336-5608
  • Fax: 216-245-6805
Mailing address:
  • Phone: 216-336-5608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number401620330314
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: