Healthcare Provider Details

I. General information

NPI: 1972449247
Provider Name (Legal Business Name): AMANDA JEAN BLACKWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 EDGINGTON LN
WHEELING WV
26003-1513
US

IV. Provider business mailing address

501 COLLIERS WAY
WEIRTON WV
26062-5003
US

V. Phone/Fax

Practice location:
  • Phone: 304-242-0217
  • Fax:
Mailing address:
  • Phone: 304-723-5440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBP00946515
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.2308884
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: