Healthcare Provider Details

I. General information

NPI: 1740603976
Provider Name (Legal Business Name): AMANDA SKOLMOWSKI MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2014
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 GLENDALE AVE STE N
TOLEDO OH
43614-1801
US

IV. Provider business mailing address

1946 N 13TH ST SUITE 420
TOLEDO OH
43604-7258
US

V. Phone/Fax

Practice location:
  • Phone: 419-476-0784
  • Fax:
Mailing address:
  • Phone: 419-720-9247
  • Fax: 419-720-0304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberS. 1200657
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberS1200657
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.1700256-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: