Provider Demographics
NPI:1679988042
Name:GILMAN, AMANDA MARIE (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MARIE
Last Name:GILMAN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 573
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-0573
Mailing Address - Country:US
Mailing Address - Phone:636-484-4371
Mailing Address - Fax:636-582-9192
Practice Address - Street 1:8 HILLTOP VILLAGE CENTER DR
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-1105
Practice Address - Country:US
Practice Address - Phone:636-484-4371
Practice Address - Fax:636-582-9192
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110284601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical