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NPI Code Detail

MEDICARE: AMANDA WILLE MSW, LSW

MEDICARE:   AMANDA  WILLE  MSW, LSW
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
1104100000XSocial WorkerS.2005284OH

General Provider Information

NPI Number : 1730969627
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA WILLE MSW, LSW
Provider Business Mailing Address
First Line : 1234 W 2ND ST
Second Line :
City : LORAIN
State : OH
Zip : 44052-1330
Country : US
Telephone Number : 419-357-6355
Fax Number :
Provider Business Practice Location Address
First Line : 310 W LAKESIDE AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44113-1044
Country : US
Telephone Number : 216-443-8272
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2023
Last Update Date : 09/29/2023

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Directions to “ AMANDA WILLE MSW, LSW” Practice Location

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