Provider Demographics
NPI:1578234746
Name:GORDLEY, AMANDA JEANETTE (AS, CDCA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JEANETTE
Last Name:GORDLEY
Suffix:
Gender:F
Credentials:AS, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 S SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2791
Mailing Address - Country:US
Mailing Address - Phone:937-414-2016
Mailing Address - Fax:
Practice Address - Street 1:602 S SOUTH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2791
Practice Address - Country:US
Practice Address - Phone:937-414-2016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator