Provider Demographics
NPI:1639593924
Name:KUJAWA, AMANDA (EDS)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:KUJAWA
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 NOLAN PKWY
Mailing Address - Street 2:
Mailing Address - City:ARCHBOLD
Mailing Address - State:OH
Mailing Address - Zip Code:43502-8404
Mailing Address - Country:US
Mailing Address - Phone:567-444-4808
Mailing Address - Fax:567-444-4801
Practice Address - Street 1:205 NOLAN PKWY
Practice Address - Street 2:
Practice Address - City:ARCHBOLD
Practice Address - State:OH
Practice Address - Zip Code:43502-8404
Practice Address - Country:US
Practice Address - Phone:567-444-4808
Practice Address - Fax:567-444-4801
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH20924122103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool