Healthcare Provider Details

I. General information

NPI: 1013749894
Provider Name (Legal Business Name): AMANDA FREDRICK LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 GLENDALE AVE
TOLEDO OH
43614-2425
US

IV. Provider business mailing address

3330 GLENDALE AVE
TOLEDO OH
43614-2425
US

V. Phone/Fax

Practice location:
  • Phone: 419-242-9955
  • Fax:
Mailing address:
  • Phone: 419-242-9955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.2614234
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: