Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | I. 0600081 SUPV | OH |
NPI | 1003146564 |
---|---|
Provider Name | Amanda Jo Adams |
First Address | Pataskala, OH 43062-7447 |
Second Address | Granville, OH 43023-9560 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2010 |
Last Update Date | 06/01/2010 |