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NPI Code Detail

MEDICARE: MISS AMANDA BLOSSOM QMHS, LSW

MEDICARE: MISS AMANDA BLOSSOM QMHS, 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.2513079OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780188284
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS AMANDA BLOSSOM QMHS, LSW
Provider Business Mailing Address
First Line : 885 COMMERCE DR
Second Line :
City : PERRYSBURG
State : OH
Zip : 43551-5267
Country : US
Telephone Number : 419-330-5122
Fax Number : 419-931-6820
Provider Business Practice Location Address
First Line : 1776 TREMAINSVILLE RD
Second Line :
City : TOLEDO
State : OH
Zip : 43613-4039
Country : US
Telephone Number : 419-214-0606
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2018
Last Update Date : 04/13/2026

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