MEDICARE: JOYCE AMLIN MRC, LSW, LICDC

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	104100000X	Social Worker	S0026067	OH
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	LICDC.902802	OH

General Provider Information

NPI Number	:	1245432269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOYCE AMLIN MRC, LSW, LICDC

Provider Business Mailing Address
First Line	:	1101 E HIGH ST
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45505-1121
Country	:	US
Telephone Number	:	937-328-5300
Fax Number	:	937-322-4900

Provider Business Practice Location Address
First Line	:	1101 E HIGH ST
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45505-1121
Country	:	US
Telephone Number	:	937-328-5300
Fax Number	:	937-322-4900

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

Provider Enumeration Date	:	06/01/2007
Last Update Date	:	12/01/2017

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