Healthcare Provider Details

I. General information

NPI: 1730810029
Provider Name (Legal Business Name): SAMANTHA JANE BEATON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2022
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 W CENTRAL AVE STE 122
TOLEDO OH
43606-1421
US

IV. Provider business mailing address

34 S ERIE ST APT 509
TOLEDO OH
43604-8259
US

V. Phone/Fax

Practice location:
  • Phone: 419-210-3660
  • Fax:
Mailing address:
  • Phone: 419-902-2490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2507532
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801121223
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: