Provider Demographics
NPI:1508372673
Name:JENNINGS, AMANDA LYNN (LISW)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LYNN
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14212 GEORGE ICE RD
Mailing Address - Street 2:
Mailing Address - City:GLENFORD
Mailing Address - State:OH
Mailing Address - Zip Code:43739-9701
Mailing Address - Country:US
Mailing Address - Phone:614-405-1234
Mailing Address - Fax:614-417-3705
Practice Address - Street 1:14212 GEORGE ICE RD
Practice Address - Street 2:
Practice Address - City:GLENFORD
Practice Address - State:OH
Practice Address - Zip Code:43739-9701
Practice Address - Country:US
Practice Address - Phone:614-405-1234
Practice Address - Fax:614-417-3705
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-27
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.22034521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty