MEDICARE: AMANDA PRICE LISW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	I 500095	OH
2	1041C0700X	Clinical Social Worker	S0900909	OH

General Provider Information

NPI Number	:	1073842753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA PRICE LISW

Provider Business Mailing Address
First Line	:	25371 STORMS RD
Second Line	:
City	:	WEST MANSFIELD
State	:	OH
Zip	:	43358-9665
Country	:	US
Telephone Number	:	740-262-8710
Fax Number	:

Provider Business Practice Location Address
First Line	:	25371 STORMS RD
Second Line	:
City	:	WEST MANSFIELD
State	:	OH
Zip	:	43358-9665
Country	:	US
Telephone Number	:	740-262-8710
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2009
Last Update Date	:	11/10/2025

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