Basic Information
| Provider Information | |||||||||
| NPI: | 1740603976 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SKOLMOWSKI | ||||||||
| FirstName: | AMANDA | ||||||||
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| Credential: | MSW, LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1946 N 13TH ST | ||||||||
| Address2: | SUITE 420 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436047258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197209247 | ||||||||
| FaxNumber: | 4197200304 | ||||||||
| Practice Location | |||||||||
| Address1: | 5115 GLENDALE AVE STE N | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436141801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194760784 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2014 | ||||||||
| LastUpdateDate: | 03/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | S. 1200657 | OH | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041S0200X | S1200657 | OH | N | Behavioral Health & Social Service Providers | Social Worker | School | 104100000X | I.1700256-SUPV | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.