Provider Demographics
NPI:1457815862
Name:NESTLER, AMANDA MARDEL GWIRTZ (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MARDEL GWIRTZ
Last Name:NESTLER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-4556
Mailing Address - Country:US
Mailing Address - Phone:785-341-0497
Mailing Address - Fax:
Practice Address - Street 1:2010 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-4556
Practice Address - Country:US
Practice Address - Phone:785-341-0497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11191104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker