Provider Demographics
NPI:1437640323
Name:SLOUGH, AMANDA MALLORY (LSW, MSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MALLORY
Last Name:SLOUGH
Suffix:
Gender:F
Credentials:LSW, MSW
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:MALLORY
Other - Last Name:PATRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:329 N WEST ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-4332
Mailing Address - Country:US
Mailing Address - Phone:419-221-3072
Mailing Address - Fax:
Practice Address - Street 1:228 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:OH
Practice Address - Zip Code:43506
Practice Address - Country:US
Practice Address - Phone:567-239-4562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS11013031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical