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General NPI Number Information
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NPI Number | 1376359935
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Entity Type | Individual
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Provider Name | AMELIA JANE FORDECK LSW CSW
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Gender | Female
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 8465 COLERAIN AVE STE 1146
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City | CINCINNATI
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State | OH
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Zip | 45239-3926
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Country | US
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Telephone | 413-364-6911
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Fax |
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Provider Business Mailing Address
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Address Line | 3351 MOUNT SOLOMON RD NW
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City | CORYDON
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State | IN
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Zip | 47112-6668
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Country | US
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Telephone | 413-364-6911
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | S.2411564
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License Number State | OH
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