Provider Demographics
NPI:1629730833
Name:SCOTT, AMANTRIA DN
Entity Type:Individual
Prefix:
First Name:AMANTRIA
Middle Name:DN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1946 N 13TH ST STE 450
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-7257
Mailing Address - Country:US
Mailing Address - Phone:419-720-6811
Mailing Address - Fax:
Practice Address - Street 1:1946 N 13TH ST STE 450
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-7257
Practice Address - Country:US
Practice Address - Phone:419-720-6811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2004716104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker