Healthcare Provider Details

I. General information

NPI: 1548051774
Provider Name (Legal Business Name): AMANDA BROOKE PWONO LSW MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA BROOKE CAHILL

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 STARR AVE
TOLEDO OH
43605-2456
US

IV. Provider business mailing address

2628 PERSIMMON DR
SYLVANIA OH
43560-1294
US

V. Phone/Fax

Practice location:
  • Phone: 419-693-0631
  • Fax: 419-936-7606
Mailing address:
  • Phone: 419-307-0255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2512157
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: